Pre-Session Client Information - Parent

IMPORTANT: This form is to be complete by the parent or caregiver of the minor seeking therapy.

*** PERSONAL DETAILS AND HISTORY OF CHILD

*** DECISION TO SEEK THERAPY

Are both parents in agreement of the above named child receiving therapy?



Is your child attending therapy of his/her own choice?



*** PAST AND CURRENT THERAPY HISTORY

*** MEDICAL AND HEALTH CARE HISTORY

*** MEDICATION DETAILS

*** PERSONAL AND FAMILY BACKGROUND

*** RELIGIOUS OR SPIRITUAL BACKGROUND

*** ADDITIONAL INFORMATION

 

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