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Home
Intake
Programs
Contact Us
Our Team
Forms
Make a Payment
Client Portal

New Client Forms-Electronic Copies

Digital forms

These new client forms can be completed online and will be submitted to your provider upon completion.

Therapy agreement/informed consent

https://na2.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhCWJugcTC4zot3DxKPPO7B85YcFN0LdPQI_Jrg-tAr1RFvui8GuGM7GQP8fIDLiMf0*

Payment Authorization form

https://na2.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhCLq-WNNYKt8bRHVKZpnufR8KkkguBaSWw7D_Wh2LiW38u6P5461Dz2fuq04ETdnpg*

Telehealth consent form

https://na2.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhDXQyOFRXISfe8WcLqK6DoLQPy9ioXtFCEhfG7TwrA8foCIqiMEZr_Rn9yHs9c0VMI*

Release of information form

https://na2.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhB5IZM6mbGYU6tQLQ0oksU_3KlNw9IvNjoX5OrA8ilKswxP9gYAD542pFC-nj8oxt0*

New Client Forms-Printable Copies

Therapy Agreement/Informed Consent (pdf)Download

Payment Authorization Form (pdf)Download

Telehealth Consent Form (pdf)Download

Release of Information (pdf)Download

Intake
Programs
Contact Us
Our Team
Forms
Make a Payment
Client Portal

IMMEDIATE OPENINGS!

-Daytime Outpatient Treatment for Addiction

*Tuesdays and Thursdays 9am-noon

-Mental Health Therapy:

*Children (ages 4 and up)

*Adolescents

*Adults

Click "Start" below to start the intake process.