Client Intake Forms

Client Intake Forms

Please find links below to all of our Client Intake Forms in PDF format. It is advised that clients download and bring in completed forms to their intake appointment along with appropriate insurance information. If you have any questions or need assistance, please call (505) 830 1871.

1. General Intake Form
2. Medical History Form
3. Clinical Policies
4. Notice Of Privacy Practices
5. Receipt Of Notice Of Privacy Practices
6. Authorization To Receive And Disclose Health Information
7. Permission for School Based Services
8. Notice Of Confidentiality Of Alcohol And Drug Abuse Patient Records
9. Request for Services by a Child 14 Years of Age or Older