Client Forms

Client Forms 2017-08-09T20:59:00+00:00

Client Forms

For Your First Appointment

There are multiple forms that need to be filled out and brought with you to your first appointment, as well as your insurance card and photo ID, which will be photocopied for our billing records. Please give the completed forms to our business staff at the front desk when you arrive.

  • Parental Consent for Treatment of a Minor
  • Release of Information & Care Coordination
  •   “Forms being revised – updates coming soon”
  • Strengths and Difficulties Questionnaire – P or T 4-10
  • “Forms being revised – updates coming soon”
  • Parental Consent for Treatment of a Minor
  • “Forms being revised – updates coming soon”
  • Release of Information & Care Coordination
  • “Forms being revised – updates coming soon”
  • Adolescent Information Form
  • “Forms being revised – updates coming soon”
  • Strengths and Difficulties Questionnaire – Parent or Teacher 11-17
  • “Forms being revised – updates coming soon”
  • Strengths and Difficulties Questionnaire – Student 11-17
  • “Forms being revised – updates coming soon”
  • CAGE Questionnaire for Adolescents
  • Client Information Form – Child 2017
“Forms being revised – updates coming soon”

  • Release of Information & Care Coordination
  • “Forms being revised – updates coming soon”
  • Client Information Form
  • “Forms being revised – updates coming soon”
  • PHQ-9 Questionnaire
  • “Forms being revised – updates coming soon”
  • World Health Organization Disability Assessment Schedule
  • “Forms being revised – updates coming soon”
  • CAGE Questionnaire Adapted to Include Drugs
  • “Forms being revised – updates coming soon”

Northeast Youth & Family Services would like to thank you in advance for choosing our agency for your health care needs. It is our pleasure serving you.