Engaging Youth • Strengthening Familes • Building Communities!

Counseling Forms

If you are scheduled for an intake at Seacoast Youth Services, we encourage you to download and complete the intake forms available on our website prior to your intake appointment. This will ensure that we can use the time together to focus on the issues that bring you here and not use session time to complete the required paperwork.  If you have any impairments that would interfere with the completion of the intake paperwork prior to your intake appointment, please let us know and we will make accommodations.

Adult Intake Form: files/Adult_Intake_Form_.pdf

Child/Adolescent Intake Form: files/Child_Intake_form.pdf




If you are making a referral to Seacoast Youth Serivces, please complete the Referral Form and either email it to This email address is being protected from spambots. You need JavaScript enabled to view it. or fax it to us at 603.372.0822.  This form is not for those seeking individual, couple, or family therapy services.  If you have any questions, please contact us at the office (603.474.3332)


Referral Form: files/SYS_Referral_Form_2015_Fillable.pdf