Child Intake Form Page 4
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4Strengths and Coping Skills:
List personal strengths
Coping Skills
Leisure activities
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Support Network:
Friends/Family members
Social Groups/Community support
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Parent/Guardian Signature_____________________________________________________ Date_______________________
Client Signature______________________________________________________________Date_______________________
Clinician Signature____________________________________________________________ Date______________________
Stone Arch Psychology and Health Services Child Intake
Page 4
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