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Parent Education Class Registration
Forms
The following are REQUIRED FORMS AND MUST BE COMPLETED BY ALL PATIENTS (A TOTAL OF Eight Forms Must Be Completed)
Intake forms
(Required For ALL Intake Form Services):
Supervised Visitation Intake Form
Alcohol/Drug Assessment Intake Form
Consent Form
Release of Information Form
Financial Policy
Good Faith Estimate
Notice of Privacy Practices
Office Policies
Patient Record of Disclosures
WHODAS Assessment Form
Expectations for Group Members (pdf)
Child/Adolescent Intake
(Required For Ages 4 -18 years old ONLY):
Child and Adolescent Intake
Behavioral Checklist
Gastric Bypass Questionnaire
Gastric Bypass Questionnaire
Additional Forms:
Credit Card Authorization Form (pdf)
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