3-C Family Services

Online Forms

Child Developmental History
New patient questionnaire you will need to complete and bring with you for your first appointment
Symptom Checklist
New patients should also complete this form
Adult Developmental History
New patient questionnaire you will need to complete and bring with you for your first appointment
Teacher Rating Scale
Client Information Form
Credit Card Authorization Form
Insurance Information Form
Fee Schedule
Authorization for Release of Information
TOPS Registration Form

Please Note:

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