IDENTIFIED CLIENT DEMOGRAPHIC INFORMATION
Please be prepared to send us a copy of your insurance cards.
LEGAL GUARDIAN DEMOGRAPHIC INFORMATION
If the client’s biological parent(s) and/or court appointment legal guardian(s) is not present at the time of the appointment, the appointment will need to be cancelled and rescheduled. All legal custody/guardianship paperwork must be sent prior to the scheduled appointment via fax or mail (must bring proof of custody if living with person(s) other than biological Parent(s). Proof must state that the person providing treatment consent and attending appointments has LEGAL rights of the child).
SERVICE HISTORY