Patient-Client Intake Form

This MLP | Boston form allows the staff member to record information regarding an unlimited number of household children.

This MLP | Boston form allows the staff member to record information regarding an unlimited number of household adults.

This MLP | Boston form provides a template for an in-depth intake interview, which allows the staff member at intake to organize as much of the information that is routinely collected as possible. Please note that this form was developed in Massachusetts. Specific agency, department, or program names may differ in other states.