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INTAKE FORMS

INCLUDING CONSENT TO TREAT AND OFFICE POLICIES

(Completed prior to your first visit)

(pdf)

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SLIDING FEE SCALE APPLICATION

(Discounted Services based on Income and Family Size) 

CCS SFS Information and Application (pdf)

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THIRD-PARTY PAYER SIGNATURE FORM

(Other entity agrees to pay for your services;  i.e. friend, family, or church) 

(pdf)

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NON-DISCRIMINATION POLICY

(pdf)

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AUTHORIZATION FORM ACH CREDIT CARD RECURRING PAYMENT

(pdf)

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