Young Person Intake Form

(Ages 13–17)

This form should be completed before the first session.

The first sections are for the parent or legal guardian.
There is a short section for the young person to complete privately where possible.

For clients under 16, a parent or legal guardian must remain on the premises during sessions.

Important. Before completing this form, please read:

Therapy Agreement
Privacy Policy

Section 1- For Parents to complete