Young & Well New Client Intake Information

Welcome to Young & Well! This intake will gather all of the important initial information we need to know about you, your child and/or your family. We also ask you to include any information we might have not asked for, but you feel is important for us to know. You are welcome to use the blank comment boxes or attach additional pages either via email or at your first appointment. If there is information you don't have on hand from a required field or do not apply, feel free to put NA and move forward with the rest of the intake. Please bring information for any items marked NA to your first session.

**Please note this intake will take approximately 30 minutes to complete.**

We're looking forward to our time together!

    Welcome to Young & Well

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