CLIENT INTAKE

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* 1. Contact Information

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* 2. Join the Collaborative Careers Newsletter

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* 3. Birth Date:

Date / Time

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* 4. Emergency Contact (Name, Phone #, Relationship to You):

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* 5. Who Were You Referred By or How Did You Hear About Collaborative Careers?

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* 6. Briefly Describe Why You Are Seeking Career Counseling?

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* 7. How Is This Affecting Your Life?

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* 8. Briefly Describe Any Past History Of Counseling:

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* 9. Anything Else Relevant That You Would Like Us To Know About You?

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