This page contains links to forms you may need to complete. Please follow directions provided by your Clinic Staff.

Screening Form:

Screening Form

This is the online fillable form. It is not savable. If you are at a computer that will allow you to complete this form in one sitting, please use this. When you are done, click the send button on the bottom of the form. If you will need more time or need to complete the form in more than one sitting, please use the printable/downloadable PDF form below.

 

Download/Print PDF Screening Form

Please use this version if you need to download to your computer to complete and attach to an email or if you would like to print out a copy and hand write the answers. If the form opens in your browser, please click the open with different viewer button at the top right corner of the window,and open in Adobe Reader (see bottom of page for link to obtain a copy of Adobe Reader) to complete the form.

 

Intake Form:

Download/Print PDF Intake Form

Please use this version if you need to download to your computer to complete and attach to an email or if you would like to print out a copy and hand write the answers. If the form opens in your browser, please click the open with different viewer button at the top right corner of the window,and open in Adobe Reader (see bottom of page for link to obtain a copy of Adobe Reader) to complete the form.

 

 

Get Adobe Reader: