Please fill out the information below and hit the done button. The questions should only take a few minutes and the information will be kept confidential. Once completed, the information will be sent by email to Guided Pathways - Support for Youth and Families. We will get back to you as soon as possible. For a quicker response please call our office at 253-236-8264.

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* 1. Necessary information.

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* 2. Your Date of Birth:

Date of Birth

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* 3. Referred By:

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* 4. Are you a returning client?

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* 5. If you are having trouble with a specific child please provide their name.

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* 6. Please enter the child's date of birth:

Child's Date of Birth

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* 7. How do you prefer to be contacted:

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* 8. What days/times are you available for appointments:

  Morning Afternoon Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 9. Household Size:

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* 10. What services are you interested in?

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* 11. Please describe the reason you are seeking services at Guided Pathways - Support for Youth and Families:

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* 12. Please enter today's date.

Todays Date

T