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CHINS Intake Assessment Form

Steps

  1. 1. Youth Information
  2. 2. Parent/Guardian Information
  3. 3. School/Services
  4. 4. Developmental/Behavioral/Social/Emotional Challenges
  5. 5. Substance Abuse Screening
  6. 6. Confidentiality and Disclosure Notices:
  • Youth Information

    1. Douglas County Georgia

    2. Douglas County Juvenile Programs CHINS Treatment Team

    3. Intake Assessment Form

    4. Yotuh's Information

    5. Gender:*

    6. Do you need a translator?*