Complete Form List

Registration Forms List by Packet

The forms below are offered in a fillable PDF format. You may fill them out online then print, or print first and fill out by hand.

New Client Packet:

If you have been seen for consultation/evaluation/treatment in the past and will be providing records, please complete the Release to Disclose Confidential Information Form, #6, and return directly to those providers.*

1. Information Form: PDF

2. Consent for Healthcare Operations: PDF

3. Child Development Questionnaire: PDF

4. Consent to Treatment: PDF

5. Privacy Policy Acknowledgement and Consent Form: PDF

6. Release to Disclose Confidential Information*: PDF

7. General Financial Policy – READ ONLY

8. Privacy Policy – READ ONLY

Adult Packet:

If you have been seen for consultation/evaluation/treatment in the past and will be providing records, please complete the Release to Disclose Confidential Information Form, #5, and return directly to those providers.*

1. Adult Information Form: PDF

2.Consent for Healthcare Operations: PDF

3. Patient Health Questionnaire: PDF

4. Consent to Treatment: PDF

5.Privacy Policy Acknowledgement and Consent Form: PDF

6.Release to Disclose Confidential Information*: PDF

7.General Financial Policy – READ ONLY

8.Privacy Policy – READ ONLY

Returning Client Packet:

1.Information Form: PDF

2.Consent for Healthcare Operations: PDF

3.Consent to Treatment: PDF

4.Privacy Policy Acknowledgement and Consent Form: PDF

5.Release to Disclose Confidential Information*: PDF 

6.General Financial Policy – READ ONLY

7.Privacy Policy – READ ONLY

 

Please send questions or comments to webmaster@childrensprogram.com