IF YOU DO NOT KNOW ANYTHING ABOUT PSYCHOLOGY DO NOT TRY TO DO THIS, PLEASE!

CLINICAL INTAKE REPORT

1. DEMOGRAPHIC INFORMATION

2. INITIAL/GENERAL IMPRESSIONS

3. REASON FOR COMING/PRESENTING CONCERNS

4. OPTIONAL SECTION #1 [Place the name of the 1st optional section that you chose here]

5. OPTIONAL SECTION #2 [Place the name of the 2nd optional section that you chose here]

6. OPTIONAL SECTION #3 [Place the name of the 3rd optional section that you chose here]

7. OPTIONAL SECTION #4 [Place the name of the 4th optional section that you chose here]

8. INITIAL TREATMENT RECOMMENDATIONS