FORMS

New Clients

Our new client forms are now able to be completed and submitted electronically.
Please complete all of the forms below.  (#1-4 are needed for ALL new clients, #5 is only needed for clients entering the 5-Day Treatment.) All sections are needed and we ask that you take the time to fully answer all questions. 
This information is used by the Director of Billing to properly submit your claims and your treatment team to begin developing a treatment plan individualized for you.  These forms are submitted via an encrypted network and are HIPAA compliant.  Please take a moment to fill these out now so any issues can be addressed promptly.

1. Registration Forms
2. Insurance and Financials
3. Statements of Understanding This form is your agreement that you have read the Client Information and Orientation Packet.This packet is for your use.  It contains important information about The Center, your rights as a client here, prescription use, cancelling appointments, etc.)
4. Responsible Party Agreement

5. 5-DAY TREATMENT ONLY: 5-Day Treatment Forms. Clients entering 5-Day Treatment need to complete these additional forms as well. 

Current Clients

Each year, The Center must collect updated information.  This is a condition of our maintaining our CARF accreditation.  Please take a moment to thoroughly complete these forms.

1. Registration Forms
2. Insurance and Financials
3. Statements of Understanding This form is your agreement that you have read the Client Information and Orientation Packet.This packet is for your use.  It contains important information about The Center, your rights as a client here, prescription use, cancelling appointments, etc.)
4. Responsible Party Agreement