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Forms

The following forms are fillable PDF forms that you can fill out on-line and email directly to our Clinic.  You may also print and mail in or bring with you on your first appointment.

If you are unable to open the forms, please visit: www.adobe.com to download the free software.

If you have any questions, feel free to contact us at: 715-732-7760

Consent for Telehealth Services During the Covid-19 Pandemic

Child/Adolescent Application for Service   (Children 17 & under)

HIPAA (submit with application)

Adult Application for Service 

     *AODA Questionaire   (submit with Adult Application for Service)

     
Please review the following Notice of Privacy Practices prior to submitting your form.

Marinette County ~ Notice of Privacy Practices

Client Rights Policy

Complainant Form