Parent Forms
For your convenience, we have made the following forms available to you, which are to be completed prior to your initial consultation. We ask that you please make every effort possible to call us as soon as you can if you know you will have to make changes to your scheduled appointment. This way, we can make the time available to another client. Here are complete directions to our office: directions to the C4L office.
Click on the form you wish to open.
Patient Intake Form
Health and Developmental History Form
HIPAA Forms
Hipaa 1996
Hipaa Acknowledgement of Receipt of Notice of Privacy Practices
Other Parent Forms
Release of Information to Third Party
Registration Forms
For Parents
Registration form: PTA, PTO, or PTF Coffee Break Session
Registration form: Family Center Parent Training Session
For Professionals
Registration form: Kids Corner Presentation(For pediatricians and health care providers)
Registration form: K-12 In-Service Workshop (For K-12 teachers and administrators)
Registration form: Family Center Mental Health Seminar for Professionals (For family center counselors and volunteers)
These forms may be printed from Adobe Acrobat Reader and returned to The Center for Learning.
If you need to download Adobe Acrobat Reader, click on the icon below.
