Parent Intake Form

This form is designed to be completed by the parent of a young adult. Please take a moment to fill out this form in detail, but no need to be verbose. As a parent, you will most-likely be asked to fill out program applications forms as well. Just share enough information with Lilley Consulting to ensure we have all the information necessary to make treatment recommendations. It is imperative that whoever is completing this parent intake form be transparent and honest about the young adult’s issues, and family history. If information is withheld, it will jeopardize the assessment and recommendation process. Know this completed form is only viewed by Lilley Consulting.

Moving forward, all reference to "client" is in regards to the young adult seeking support. Young adult and client is used synonymously. When you complete the form, you will receive a confirmation page that the information you filled out has been sent to Lilley Consulting.

When you start form, know there is no ability to “save & pause.” You must complete the form in one sitting.

This form does ask for insurance information. After submitting this form, if you haven’t already, please email Joanna with a front & back picture of your insurance cards as well.