Court Supervision Intake

Step 1: Court Supervision Intake
(To be done before ANY form of assessment)

PLEASE NOTE: We accept ALL clients into our programs, with the exception of Abusive, Violent Offenders and Non Ambulatory Clients since we currently do not have the capacity to work with them.

Assessments are Conducted on Tuesdays or Wednesday ONLY during this time our staff member will ask a series of questions and gather necessary documentation to get started with services. Staff members will also do a brief introduction of instructors so that the client will know who will becoming to see them. Assessment Reports are completed by the following Wednesday.

The Program Coordinator will contact the client within 24-48 hours via telephone to set up the assessment appointment. If the client does not respond within the first 48 hours a letter of attempting to contact will be sent out. Then after the coordinator will make one last final attempt to contact the client before informing the regional center that the client is unavailable for the assessment. It will be then up to the regional center case manager to contact the client and inform them that we are trying to reach them.

Is this a.... *

New Service Change Cancel Re-authorization (Progress Report Needed)

* Indicates required field

Service Type *

For Vocational Rehabilitation Clients assessments and appointments are done on Wednesdays only until further notice. Please click the question mark after the rules on how Regional Centers like things to be done.

Assessment Start Date? *

Service (POS) start Date? *

Termination Date? *

Service (POS) Termination Date? *

New Client, Basic Information

Please provide us with the following information about the client:

Client UCI or Case Number *

Prospective Client Name *

First

Last

Gender *

DOB: (IE: 01-13-1976) *

Clients Age *

Address *

City *

Zip *

Clients Parents Name (if under 18 or Conserved) or 1st Child's Name *

First

Last

Client Phone Number *

Home Phone or 2nd Number *

Clients Parents Phone Number *

Clients Email Address *

Second Contact Person Name (If any) *

First

Last

2nd Contact Person Phone Number *

Clients Diagnosis/Noticeable Behavioral Patterns *

What are the clients current IPP Objective/Date and Number if any? *

Case manager, "If are at the computer, can you please send me over your clients file or any information that you have on him or her so I can add it to our computer system? " *

In order to help us serve our clients better:
You can upload the information or send them to ServiceRequest@LeBLancConsulting.net

Assessment POS
POS
Health Documents
Psychological Evaluation
School Documents
Court or Legal Documents
Other Documents you may have