This form is to be completed by clients prior to their first appointment; this provides background and foundational information for clinicians to review prior the the intake appointment. This form includes all information required to be assessed as part of the intake process. 
 
It is your responsibility to keep up on any future changes in requirements. Neither Awareness to Wellness, LLC nor Alison Alsleben, LICSW, LCSW is to be held liable for any documentation changes after purchase of forms.