Minor Intake Form and Consent for Treatment

Dear Parent/Guardian, please complete the following Intake Form as thoroughly as possible. While we take every effort to ensure privacy, we recognize that online documents might have a digital footprint. Because the nature of the information in this document is sensitive, we therefore ask that you do not use full names, only initials, when referring to yourself, your child/teen, and other family members.  The PDF document which your print out will contain the names and other details that we will need.  Thank you.