Welcome to my practice.  I want to make the most of each appointment you have with me.  One way of doing this is for you to fill out this intake form to the best of your ability.  I realize that you may not remember or have access to all of this information but do the best you can.  This will help me better understand and work with you.  This information is confidential.  If you have concerns about the relevance of any information and wish to leave it out, please feel free to do so.