Adult Mental Health Intake Form 2023

Adult Mental Health Intake Form

(Adult refers to those aged 19+)

Please fill out the form to the best of your ability.

The more information you can fill out on this form, the more helpful is is for us at REACH to determine a support plan for you. If you do not know, or do not feel comfortable filling out the information, that is alright; please put n/a in any box you do not want to fill or that you do not have the information for.