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Summary
Program Intake Form (PDF)
This three-page form is designed to gather initial information about people and their health behaviors. It can be completed by a patient alone or with a health professional.
Author site: Galveston County Health District I 2004
Related links
- For other tools related to general program administration: Click here
- For other tools on multiple self management behaviors: Click here
- For more assessment tools: Click here
- For other tools on program management & implementation: Go back
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