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Departments » Health and Human Services » ADAPT Clinic
Forms

The following forms are fillable PDF forms that you can fill out on-line and email directly to our Clinic at 7760@marinettecountywi.gov


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

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

HIPAA (submit with all paperwork)

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