BEHAVIORAL HEALTH INFORMATION


What services are you seeking? 

What is the main reason you’re seeking services at this time?

Please mark any concerns you or your child have in the following areas.  (Select only those that apply to the client).

The following symptoms affect or may be affected by your (or your child’s) behavioral health needs.  Please check if any of the following are currently affecting your life.

Are you (or your child) currently taking any medications? 

If yes, what?

Other concerns or issues: 
 

Client Name :  

Relation to Client :

 

Leave this empty:

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Options Counseling & Family Services https://wp.options.org
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Document name: BEHAVIORAL HEALTH INFORMATION
lock iconUnique Document ID: 833e33e639f1890c03bc3eb9fb9afb4f4c429a47
Timestamp Audit
May 11, 2020 9:20 am PDTBEHAVIORAL HEALTH INFORMATION Uploaded by Adam Falk - adam.falk@options.org IP 50.240.25.195
May 11, 2020 9:36 am PDTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 50.240.25.195
May 20, 2020 8:07 am PDTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 50.240.25.195
May 20, 2020 8:11 am PDTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 50.240.25.195
May 20, 2020 8:11 am PDTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 50.240.25.195