Module 39 Lab
Client Intake
This lab is designed to provide an opportunity for you to practice completing the clinic form prior to your Field Practicum. Your submitted form will not be graded, but submitting a photo of your completed form is required to receive credit. If you have any questions regarding the form, refer to the Learning Module. The MFT Instructor for your Field Practicum will explain the form again and answer any of your questions.
Forms: Get a full-size clipboard and start assembling your clinic forms. Print each form linked below:
- Medical-Fitness Chart
- Screening Questionnaire
- Informed Consent
Scenario: Complete the "Client Profile" section of the Medical-Fitness Chart using the information listed below. Print legibly.
Take a close-up photo of the Client Profile section of the Medical-Fitness Chart form that you completed.
- Your client's name is Joseph Gerard
- He arrived for his clinic appointment on May 19, 2024
- You started his Medical-Fitness Assessment (Intake) at 10:30
- You noticed that your client is male.
- Your client stated that he is 37 years old.
- Your client gave you his Date of birth as March 12, 1987.
- His answers to your screening questions were: No and No.
- He read and signed the Informed Consent.
- After completing his Assessment, your client gave you his phone #: (234) 567-8901, and email: [email protected] (Fill-in the blanks now for completeness.)
Take a close-up photo of the Client Profile section of the Medical-Fitness Chart form that you completed.
Lap Report