Trichotillomania Therapy Intake Form for Children

Trichotillomania Therapy Intake Form for Children

Supporting children with trichotillomania requires understanding the complete picture—from when the pulling began to how it affects their daily life at home and school. This Trichotillomania Therapy Intake Form for Children is designed specifically for mental health professionals, therapists, and counselors who work with pediatric clients experiencing hair-pulling disorder.

Why this form matters

Trichotillomania affects 1-2% of children and adolescents, and early intervention is key to successful treatment. This intake form captures the clinical detail you need to create an effective, personalized treatment plan—including onset patterns, pulling locations, emotional triggers, parental responses, and academic impact—all in one streamlined document.

Built for mental health professionals

Whether you're a child psychologist, licensed counselor, or behavioral therapist, this form is tailored for your practice. It gathers comprehensive information about:

• Pulling onset and history: When the behavior started, duration, and progression
• Location patterns: Which areas of the body are affected and to what degree
• Triggers and contexts: Emotional states, situations, and environmental factors
• Parental awareness and response: How caregivers have addressed the behavior
• School and social impact: Academic performance, peer relationships, and self-esteem
• Previous interventions: What's been tried and what's worked

Seamless workflows with Paperform + Stepper

This template isn't just a form—it's the start of your client journey. With Paperform, you can customize the questions to match your practice's approach, embed the form on your website, and collect responses securely in compliance with SOC 2 Type II standards.

Connect this intake form to Stepper to automate what happens next: automatically create a client file in your practice management system, send a welcome email with next steps, schedule an initial consultation, or notify your admin team when a new pediatric client needs attention. No manual data entry, no missed follow-ups—just smooth, professional client onboarding that lets you focus on care.

For therapists who care about details

This form is ideal for counselors, psychologists, and child behavioral specialists who treat body-focused repetitive behaviors (BFRBs) and want to gather thorough intake information without overwhelming young clients and their families. It balances clinical depth with a compassionate, accessible tone that helps parents feel supported from the very first interaction.

Start with this template, customize it to your practice, and create an intake experience that builds trust and sets the foundation for effective therapy.