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Form Details

• Form Properties
  1. Form Title: Initial Client Contact - Referent
  2. Start from an Existing Form - No
  3. Copyrighted Form - No
  4. Billable Progress Note - No
  5. Have multiple versions open at same time - No
  6. Open Blank on new version - No
• Required Fields - None
• Lookup Tables - None
• Pre-Fill Logic - Conditional
  1. If using the Pre-Intake Module, no information will prefill.
  2. If the patient is already registered and placed into a chart the Address will prefill from Patient Details.
• Fill to Logic - None
• Signatures - None

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Client Tab

1. Select the type of clinic the client was referred to (if applicable).
2. Enter any client data (if applicable).
   • Address will prefill from Patient Details.
3. Enter any information of the person the client was referred by (if applicable).
4. Enter the financial ability of the client (if applicable).
5. Check if informed Self pay client of $250 Intake fee and $25 UDS (if applicable).

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Personal Tab

1. Enter any personal information (if applicable).
2. Schedule an appointment (if applicable).
   • Selecting Schedule will open up the scheduler (see Scheduler).

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