How to fill out the intake form

Introduction: About The Intake Form

After guardian is done with creating an account, the next step for them is to fill out intake form.

The Intake form consists of several questions, divided by category. Each category of questions is important for clinicals to match child’s need with experienced and appropriate therapists and doctors.

Questions which guardian need to fill out in intake form are relate to:

• Basic contact information and care location
• Level of verbal behavior
• Aberrant and maladaptive behaviors
• Communication, social interaction and self-development
• Additional context about your child (e.g. goals of therapy, co-morbidities, and funding source)

What does each question mean? 

Questions related to level of verbal behavior covers all information about child’s existing level of understanding information as a speaker or listener 

Questions about aberrant behaviors covers all information about child’s aggression, self-injury, elopement, property destruction

Questions about maladaptive behaviors covers all information about child’s engaging in self-stimulation in the form of stereotypical and/or repetitive behavior, rigidity, or intense preoccupations/perseveration 

Questions about communication, social interaction and self-development covers all information about child’s delays with expressive or receptive language, delays in social/emotional reciprocity, ,difficulty recognizing safety risks, or problems with grooming/eating/toileting skills.

Need More Help?

If you have any questions, comments, or suggestions, please reach out! We want to build the best tool for you, so please don’t hesitate to let me know your feedback.

Please contact me directly at calvin@teamworkcares.com. I’ll get back to you within 24 hours!