BHS Intake Forms

* Have you already spoken with our Intake coordinator and set-up your initial Intake Appointment? If not… Before you complete and submit the Intake Forms, please contact Youth For Tomorrow Behavioral Health Services at 703-955-3187 and speak with our Intake Coordinator. This Individual will determine if we are suited to meet your needs and will then schedule your first intake appointment and at what location with BHS.  

  • Before you complete each form, please make sure to read each set of instructions.  Once you have completed these forms, you may fax them to 571-364-8913 or bring it to your first appointment.
  • Intake paperwork must be entirely filled out prior to beginning services.  Incomplete or missing information may result in a rescheduling or canceling of the initial intake.
  • If you are a parent, legal guardian, court-appointed guardian or have power of attorney, you are responsible for completing the paperwork for individuals under the age of 18.

Step 1: Client Contact Information

This form gathers the most current demographic information on file for your record only. Please make sure that information entered is up-to-date. To begin click here

Step 2: Service Agreement
Please read the entire document before signing as it pertain directly to the services rendered at YFT Behavioral Health Services. To begin click here

Step 3: Rights and Responsibilities

It is of the utmost importance to us that you are fully aware of your rights and responsibilities as our client before services are rendered. To begin click here

Step 4a: Adult Client Information

If the new client is 18 and older please complete this form. To begin click here

Step 4b: Child and Adolescent Information

If the new client is 17 or younger (minimum age: 5 years old) please complete this form. To begin click here

Additional Form for all Current Clients

Authorization to Release Personal Health Information

If there is a third party involved in your treatment (or your child’s treatment) with whom it would be helpful for YFT to communicate (e.g. school guidance counselor, primary care physician, previous therapist, other family members or supports, etc.), it is your choice if you would like to authorize us to exchange information with that individual or organization. Please fill out as many of these forms as needed and give them to your assigned therapist. To begin click here