For more information or to schedule an appointment please call (618) 988-1330.
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Downloads

Downloads (5)

  • Adult Psychosocial Form
    This form must be filled out in addition to the Registration form for Insurance or Self-Pay Clients ages eighteen (18) and older.
  • Child/Adolescent Psychosocial Form
    This form must be filled out in addition to the Registration form for Insurance or Self-Pay Clients ages seventeen (17) or younger.
  • Registration Forms for Adoption Preservation Clients
  • Registration Forms for Insurance Clients
    All fields on this form must be completed. If the client is twelve (12) to seventeen (17) years of age he or she and the guardian must sign the paperwork. For clients eleven (11) years of age or younger, only the guardian must sign the paperwork. For adults eighteen (18) years of age or older, only his or her signature is required. Please remember to complete the Psychosocial Form as well. Children and adolescents seventeen (17) years of age and younger, complete the Child/Adolescent Psychosocial form. Adults eighteen (18) years of age or older, complete the Adult Psychosocial form.
  • Registration Forms for Self-Pay Clients
    All fields on this form must be completed. If the client is twelve (12) to seventeen (17) years of age he or she and the guardian must sign the paperwork. For clients eleven (11) years of age or younger, only the guardian must sign the paperwork. For adults eighteen (18) years of age or older, only his or her signature is required. Please remember to complete the Psychosocial Form as well. Children and adolescents seventeen (17) years of age and younger, complete the Child/Adolescent Psychosocial form. Adults eighteen (18) years of age or older, complete the Adult Psychosocial form.

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