BEHAVIORAL HEALTH INFORMATION


Client Name:

Options Location:

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: 832d623996f084498bc7b641c191f538b2decc18
Timestamp Audit
May 11, 2020 9:20 am PSTBEHAVIORAL HEALTH INFORMATION Uploaded by Adam Falk - adam.falk@options.org IP 108.174.191.234
May 11, 2020 9:36 am PSTOptions 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 PSTOptions 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 PSTOptions 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 PSTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 50.240.25.195
October 27, 2020 10:44 am PSTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 108.174.191.234
October 28, 2020 8:12 am PSTOptions Records - OCFSrecords@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 108.174.191.234
October 30, 2020 10:36 am PSTOptions Intake - intake@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 108.174.191.234