If you are a self-paying client or applying for funding, please make sure to bring proof of income and photo id with you to your visit. If you are paying with insurance, please make sure to bring your insurance card, co-pay, and a photo ID with you to your visit.
To download a form, click the appropriate language underneath the service you are requesting. Please be sure to print clearly and in blue or black ink.
| New Clients | ||
|---|---|---|
| (Clients who have not been seen in over a year) | ||
| English | Español | |
| Existing Clients | ||
|---|---|---|
| (Clients who have been seen within a year) | ||
| English | Español | |
| Take Charge Application | ||
|---|---|---|
| English | Español | Russian |
| Additional Forms | ||
|---|---|---|
| Release of Information (Eng/Spa) | Fact Sheets | |
