div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: Scanned Document · MINDS COUNSELING INTAKE FORM Gail W Clift MSN CPNP CMHNP Todays Date Childs Name Childs Date of Birth Referral Source Please describe the reason you are src=https:reader034vdocumentsnetreader034viewer20220424045f1c374ec2b19d4f0728ac8fhtml5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: Scanned Document · MINDS COUNSELING INTAKE FORM Gail W Clift MSN CPNP CMHNP Todays Date Childs Name Childs Date of Birth Referral Source Please describe the reason you are src=https:reader034vdocumentsnetreader034viewer20220424045f1c374ec2b19d4f0728ac8fhtml5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: Scanned Document · MINDS COUNSELING INTAKE FORM Gail W Clift MSN CPNP CMHNP Todays Date Childs Name Childs Date of Birth Referral Source Please describe the reason you are src=https:reader034vdocumentsnetreader034viewer20220424045f1c374ec2b19d4f0728ac8fhtml5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: Scanned Document · MINDS COUNSELING INTAKE FORM Gail W Clift MSN CPNP CMHNP Todays Date Childs Name Childs Date of Birth Referral Source Please describe the reason you are src=https:reader034vdocumentsnetreader034viewer20220424045f1c374ec2b19d4f0728ac8fhtml5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: Scanned Document · MINDS COUNSELING INTAKE FORM Gail W Clift MSN CPNP CMHNP Todays Date Childs Name Childs Date of Birth Referral Source Please describe the reason you are src=https:reader034vdocumentsnetreader034viewer20220424045f1c374ec2b19d4f0728ac8fhtml5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdiv