Please print and fill out these forms and bring them to your
appointment if so directed by the secretary.

Fall 2009 Schedule of Classes and Workshops (55 KB PDF file or 58 KB Word file) UPDATED!

1) Information Form (92 KB PDF file or 33 KB Word file)

2) Consent for Payment and Healthcare Operations (23 KB PDF file or 30 KB Word file)

3) Child Development Questionaire ( 28 KB PDF file or 67 KB Word file )
    Adult Questionaire (80 KB PDF file or 45 KB Word file)

4) Release to Disclose Confidential Information (22 KB PDF file or 29 KB Word file)

5) Consent to Treatment (43 KB PDF file or 42 KB Word file)

6) Healthcare Coordination Form (64 KB PDF file or 25 KB Word file)

7) Acknowledgement and Consent Forms (71 KB PDF file or 28 KB Word file)

8) Consent to email the Children's Program

9) Financial Policy (13 KB PDF file or 31 KB Word file)

10) Privacy Policy Forms (123 KB PDF file or 44 KB Word file)

11) ADD/ADHD Beginner's Group (131 KB PDF file or 111 KB Word file)
11a) ADD/ADHD Fall 2009 Calendar (19 KB PDF file or 30 KB Word file)
11b) ADD/ADHD Winter 2010 Calendar (18 KB PDF file or 30 KB Word file)
11c) ADD/ADHD Spring 2010 Calendar ( 18 KB PDF file or 30 KB Word file)

12) Caseworker Information (54 KB PDF file or 20 KB Word file )

13) DHS Evaluation Referral Request (15 KB PDF file or 29 KB Word file)

14) Registration Form (22 KB PDF file or 28 KB Word file)