Electronic Client Intake Forms
In order to better serve our clients, we are now offering our intake forms electronically.
The following forms are required to be filled out for anyone seeking counseling and/or case management services. The forms include a large amount of information, some of which may not apply to you. Please answer all applicable questions as thoroughly as possible.
There is the possibility that due to the nature of some of the questions, a person could have difficulty responding to particular sections. If this occurs, simply fill in as much information as you are comfortable, and you can discuss this more with your intake clinician.
Download your forms using the links below.
If you have issues or questions, please email email@example.com for assistance.
In order to fill the forms electronically, you must have a version of Adobe Acrobat installed on your computer. Download Acrobat for free here.
You will also need to create a new Digital ID in order to electronically sign the forms. Please follow instructions in Adobe.
Consent for Emergency Medical Care
Eligibility Form Consumer Part
Intake Assessment + PHQ-9 + GAD7
IOP Orientation Packet
STRMU Eligibility Packet
STRMU Renewal Packet
TBRA Eligibility Packet
TBRA Landlord Packet
COVID-19 Relief Application
Solicitud de subvencion de alivio
Client Satisfaction Survey
Once you have completed your forms, please upload them below.
Make sure your forms are saved with this filename format: “FirstNameLastInitial_FileName”
Ex. JohnD_Consent for Emergency Medical Care