Download and Print Intake Forms

Please download, print and fill out (when applicable) every form included in this list prior to your enrollment appointment. A staff member will review, and you may be asked to edit a form that requires correction. If you would prefer to fill out online, please follow this link https://forms.childandfamilyagency.org/forms/forms-individual/billable-intake-forms/.
Statement of Custody, Application for Services and Service Agreement
Grievance Procedure
Attendance Policies
Client Rights and Responsibilities
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgment
Release of Health Information and Assignment of Benefits
Financial Agreement
Consent and Notice Regarding Electronic Signatures
Consent to Telehealth and Electronic Communication Agreement
Authorization for Health Information Exchange