Please complete one of the client intake forms that represents the age of the client: (choose only one)
All forms here are required: (4 total)
Optionally, for self pay/copay insurance members:
Optionally, if the client is transferring from another provider/organization, please choose and complete one of the following forms: (choose only one)
If the client is NOT represented by a parent, guardian, or personal representative:
If the client is represented by a parent, guardian, or personal representative: