|
If you are seeking services for yourself, please download and read the HIPPA FORM, then fill out (either by typing directly on the form, or printing out a blank form and filling it in by hand) the INTAKE FORM and ADULT HISTORY FORM. Bring these TWO forms (Intake, History) with you to your appointment.
If you are seeking services for a child (17 and under), please download and read the HIPPA FORM, then download and fill out (either by typing directly on the form, or printing out a blank form and filling it in by hand) the INTAKE FORM and CHILD HISTORY FORM. Please also download the TEACHER FORM and give to your child's primary teacher to fill out before your appointment. Bring these THREE forms (Intake, History, Teacher) with you to your appointment.
If you have any questions, please call us at (480) 998-2303.
HIPPA form
Click filename below to access file
Intake Form
Click filename below to access file
Adult History Form
Click filename below to access file
Child History Form
Click filename below to access file
Teacher Form
Click filename below to access file
Records Release
Click filename below to access file
Adoption History Questionnaire
Click filename below to access file
Copyright © 2012, The Nicholls Group
9965 N. 95th St., Suite 101
Scottsdale, AZ 85258
ph: (480) 998-2303
|
