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NEW CLIENT ON LINE CLINICAL FORMS HANDBOOK
 
     
 

We appreciate having the opportunity to be of service to you or to your loved one. As a part of our efforts to get to know you and to learn more about you, we are requesting that you complete the following forms to assist us in our assessment process.

These forms are listed by various age groups and the title and purpose of each form are also listed. The name listed for each form is a link to that particular form. You have two options to complete the forms depending on how you would like to complete them. These options include: (1) Print out the form on your printer and either fax it to our office or bring it in at the time of your first session with us. Our fax number is (281) 444-0368 and it is on 24 hours a day for your convenience. It is a confidential fax that only our staff has access to; and (2) You can complete the forms on line if you have Microsoft word processing products including Word 97, Word 2000, Microsoft Office and Microsoft Works. The clinical form versions to be completed on line with Microsoft word processing programs are listed in the second grouping of forms listed on this page. Please complete these forms on line and then email them to jagvw@earthlink.net when they are completed.

PLEASE NOTE THAT THESE FORMS ARE AVAILABLE THROUGH MICROSOFT PRODUCTS INCLUDING WORD 97, WORD 2000 AND MICROSOFT WORKS.

 
     
FORM NAME
FORM PURPOSE
WHEN TO SUBMIT FORM
ADULT FORMS-CLIENT COMPLETES AS NEEDED. COMPLETE THE ADULT INTAKE FORM AND THE ADULT AUTOBIOGRAPHY FORM. OTHERS MAY BE REQUESTED BY DR. GARLOCK.

Adult Intake Form

(WORD FILE)

Demographic Information And Issue Focusing Before First Session or Immediately After It

Adult Autobiography

(WORD FILE)

History And Needs And Treatment Planning Before First Session or Immediately After It

Adult Marital/Relationship Questionnaire

(WORD FILE)

Relationship History And Issues And Tx Planning Before First Session or Immediately After It
Substance History And Issues And Tx Planning As Requested By Dr. Garlock
ADOLESCENT FORMS-PARENT COMPLETED EXCEPT FOR SUBSTANCE ABUSE EVALUATION FORM. COMPLETE THE ADOLESCENT INTAKE FORM. OTHERS MAY BE REQUESTED BY DR. GARLOCK AS NEEDED.

Adolescent Intake Form

(WORD FILE)

Demographic Information And Issue Focusing Before First Session or Immediately After It

Adolescent Biography Form

(WORD FILE)

History And Needs And Treatment Planning Before First Session or Immediately After It

Adolescent Behavioral/ Emotional Assessment

(WORD FILE)

Behavioral and Emotional Functioning Assessment Before First Session or Immediately After It

Adolescent Substance Abuse Evaluation-Self Completed

(WORD FILE)

Substance History And Issues And Tx Planning As Requested By Dr. Garlock

Adolescent Developmental Form

(WORD FILE)

Developmental History And Treatment Planning Before First Session or Immediately After It
CHILD FORMS-PARENT COMPLETED. COMPLETE THE CHILD INTAKE FORM AND THE CHILD DEVELOPMENTAL FORM. OTHERS MAY BE REQUESTED BY DR. GARLOCK AS NEEDED.

Child Intake Form

(WORD FILE)

Demographic Information And Issue Focusing Before First Session or Immediately After It

Child Biography Form

(WORD FILE)

History And Needs And Treatment Planning Before First Session or Immediately After It

Child Behavioral/ Emotional Assessment Form

(WORD FILE)

Behavioral and Emotional Functioning Assessment Before First Session or Immediately After It

Child Developmental Form

(WORD FILE)

Developmental History And Treatment Planning Before First Session or Immediately After It