New Client Intake Appointment

  • New Client Intake Appointment

    To schedule an a new client intake appointment, please complete the following questions. Both you and your child/client must be present during the intake. *All intakes are done in-person at the Amplify Life office*
  • Is your son/daughter 16 years or older?*

  • Appointment Details

  • Please select an appointment date and time*

  • Client Information

    Please provide some information on your child/participant.
  • Do/Did they have a 1:1 aide at school?*
  • If yes to above, would you be able to provide a 1:1 during programming?*
  • Are they independent in the restroom?*
  • Do they show/have an aggressive behaviors towards themselves or others?*
  • Have your child/participant ever been in trouble with the law?*
  • Is your child/participant prone to seizures?*
  • If your child/participant is prone to seizures, are they controlled by medication?

  • Parent/Caretaker Information

    Please provide your information.
  • Relationship*
  • Format: (000) 000-0000.
  • Are there any programs in specific you are interested in?*
  • How did you hear about us?*

  • New Client Intakes are done in person at the Amplify Life Office. Both you and your client/child must be present for the intake.

  • Once you submit, you will receive a confirmation email for your appointment, along with an attachment of directions to our office.

    We are the big white building with the green trim on the Northern Nevada Adult Mental Health Services Campus. Please knock on the Office Door.

  • At this time, your son/daughter does not meet the age requirement for Amplify Life programs, as participants must be at least 16 years old.

    We apologize for any confusion and truly appreciate your interest in our programs. Once your son/daughter reaches the eligible age, we would love for you to register again, and we’ll be happy to connect with you then.

  • Thank you for your interest in Amplify Life!

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