Youth Intake Forms
Please bring the completed Counseling Policies, Personal History & Youth SDQ Screening forms to your first appointment.
If you are unable to complete your intake forms ahead of time or forget to bring them, you will need to arrive 15-20 minutes early. Extra forms are available in wall files in the waiting area.
Click on a form title below to open a PDF document of that form. You will need Adobe Reader to view & print these documents. It's FREE and you can get it here.
If you are unable to complete your intake forms ahead of time or forget to bring them, you will need to arrive 15-20 minutes early. Extra forms are available in wall files in the waiting area.
Click on a form title below to open a PDF document of that form. You will need Adobe Reader to view & print these documents. It's FREE and you can get it here.
Wellness Assessments - UBH/Medica Insurance ONLY
For clients with Medica insurance, in addition to the general intake forms, please bring the completed Wellness Assessment to your first appointment. 
| Youth SDQ ScreensPlease note that for ages 3-4 and 4-10, only a parent SDQ screen is required. Ages 11-17 require both a youth & a parent SDQ screen.
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Electronic SDQ Screens
You can also visit the SDQ website via the links below to complete electronic versions and bring the computer generated report to your intake session.
Remember:
Ages 11-17 require both a youth & a parent SDQ screen. Ages 4-10, only a parent SDQ screen is required.
Website Links:
Youth SDQ - 11-17 yr olds
Parent SDQ - 4-17 yr olds
Teacher SDQ - 4-17 yr olds