Client History - Adolescent (Part 1) | Natalie Harvey | MFT

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Client History - Adolescent (Part 1)

First name

Last name

Date of Birth

Month

Day

Year

First Name (Mother)

Last name (Mother)

First Name (Father)

Last name (Father)

Previous Mental Health Treatment (Please explain in detail below)

Psychological Testing:

Yes

No

Psychological Testing: If yes, date of testing:

Month

Day

Year

Educational Testing:

Yes

No

Educational Testing: If yes, date of testing:

Month

Day

Year

Presenting Complaints:

Client’s strengths:

Please continue to Part 2.

© 2026 by Natalie Harvey, M.S., M.F.T.

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