Intake Forms
Empowering Minds, Transforming Lives
Getting Started is Easy
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Welcome to Caring Space! To ensure we can provide you with the best possible care, please complete the required forms before your first appointment. Our HIPAA-protected online forms make the process simple and secure.
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Click on the appropriate form link below
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Complete all required fields thoroughly and accurately
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Submit your form securely online
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Bring your insurance card and ID to your first appointment
Please allow 15-20 minutes to complete your intake form. If you have any questions, don't hesitate to contact our office.
New Client Intake Forms
Adult Intake & Consent Form
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For individuals 18 years and older seeking mental health counseling services. This HIPAA-protected online form includes personal information, medical history, and consent for treatment.
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Required for: Individual therapy, couples counseling, and adult group therapy sessions.
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Complete time: Approximately 15-20 minutes
Child & Adolescent Intake & Consent Form
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For clients under 18 years of age. This HIPAA-protected online form must be completed by a parent or legal guardian and includes consent for treatment of minors.
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Required for: School-based counseling, individual therapy for children and teens, and family therapy sessions.
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Complete time: Approximately 15-20 minutes
What to Bring to Your First Appointment
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Current insurance card and ID
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List of current medications and dosages
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Previous mental health records (if available)
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Your intake forms will already be on file when you arrive, so you can focus on your first session!
Need Help?
​If you have questions about the intake forms or need assistance, our team is here to help.
Phone: 440-724-7594
Email: QualityAssurance@caringspaceohio.com
Address: 4614 Prospect Ave, Suite 223, Cleveland, OH 44103
Office Hours: Monday - Friday, 9:00 AM - 5:00 PM