Client Intake Form

Instructions on how to complete the overall process:

Step 1:

Answer each question

Step 2:

Reverse your scores for question for 4 questions: 4,5,7 and 8. 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0.
Step 3:

Add up your scores for each item (questions 1 -10) to get a total score.

Brief intake information: