Forms Required for Intake Appointment

When you decide to become a client of Fremont Counseling we will schedule an intake or clinical assessment appointment for you.  In order to make sure that we have as much input and information from you as possible, we would appreciate it if you would bring the following completed forms with you to this appointment.

Client Information Form:
This is the information that we need in order to open you as a client.

All information on the form is required and this must be completed for all intakes (adults and children/adolescents).

Please click here to open this form:  Client Information Form

Intake Form (Adults and Children):
This form asks for information about your symptoms and what you would like our help with.  We also ask you questions about your family, employment history, education, medical history and other important questions which will help us learn more about you.   Please answer the questions as best as you can.

Adults will complete the form for themselves.  Parents/guardians of children will be required to complete this form with information about the child.

Please click here to open this form:  Intake Form (Adults and Children)

Additional Intake Information for Children:
Your children are important to you and they are important to us, too.  So much so that we have some additional questions to ask about your child’s development, social skills, behaviors and other important questions which will help us learn even more about them.

Parents/guardians of the child/adolescent will be required to complete this form with information about the child.

Please click here to open this form:  Additional Intake Information – Children