Tomaro's C.H.A.N.G.E. - A Nonprofit Organization Providing Behavioral/Mental Health Services to Children, Adolescents, & Families in Office, Community, Schools, & Online Setting
  • Welcome!
  • Our Mission
  • Our Team
  • Groups & Classes
  • Services & Fees
  • the YES Program
  • Contact TC
  • Welcome!
  • Our Mission
  • Our Team
  • Groups & Classes
  • Services & Fees
  • the YES Program
  • Contact TC
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YOUR CART

Welcome to Tomaro's C.H.A.N.G.E. where we work with you in creating healing answers & necessary guidance for excellence! We thank you for choosing us, and we promise to work side by side with you, providing you with quality care and attention, and family centered services that will assist you in making your desired transition into the next phase of your life.

Youth Intake Form ~ Complete, Sign & Submit
​(Must be completed prior to initial meeting!)

    Contact Information


    Child/Adolescent Questionnaire

    Please review the questions below; reflect on the past 2 weeks and complete them to the best of your ability. The information collected will assist your child's counselor/coach in creating a plan that will assist them in your goals. Please take note that there are two sides to the form. If your child is under 12 years of age please complete the 'child' side of the form; if the child is 12 and over please complete the adolescent side of the form.

    Presenting Problems/Concerns

    CHILD ~ Under Age 12

    ADOLESCENT ~ 12 years and older

    Are the child's issues affecting any of the following?

    ​Family & Developmental History


    Medical History


    Substance Use History

    If you answered yes to the above question then please answer the questions below, otherwise proceed to the next section of the intake form. 

    Education

    If you answered yes to the question above, please answer the following questions; otherwise please proceed to the next section. 

    Interpersonal/Social/Cultural Information

    ​​Please click below in order to submit your Intake Form. You will be forwarded to the appointment page!​

SUBMIT ~ I CONFIRM THAT I HAVE READ & AGREE TO TOMARO'S CHANGE'S POLICIES & SERVICES.
TC'S POLICIES & PRIVACY PRACTICES
​Contact TC
Meet Team CHANGE
​About TC Groups
Join A Group or Class 
About Nontraditional Counseling
​
Register for Divorce/Separation Class
Join Our Mission toward Mental Health Wellness for Youth
​​Volunteers or Donations for Services
​Human Sex Trafficking
​Check Out What Previous Clients Are Saying About US 
TC Policies & Privacy Practices
​​​FAQs
​​TC's Village ~ Blog
​TC Events

​TC's Partners
WHILE WE ALL ARE EXPERIENCING THE STRUGGLES OF COVID-19, WE CONTINUE TO BE HERE TO SUPPORT OUR COMMUNITY
Copyright 2010-2020. All rights reserved by Tomaro's C.H.A.N.G.E.