Paperwork for New and Returning Clients
Our IntakeQ client portal system requires cookies to be enabled to allow clients to access forms online.
PLEASE NOTE: Ongoing clients and referrals from Madison County Physicians have priority for Attention Assessments.
We have a wait list of @ 2 months for other Attention Assessments.
To begin the process of becoming a client,
COMPLETE ONE OF THE TWO FORMS BELOW
After you complete and submit the forms, you will be taken to the next step.
After clicking “submit” please wait until directed to another web-page.
Please use the NAME of the Person Who will be the Actual CLIENT!!!
for ADULTS: Click Here
for a MINOR CHILD** or a Dependent Adult: Click Here
**PLEASE NOTE: We will need to have copies of ALL custody paperwork BEFORE we can schedule a minor child for treatment
If you have difficulty completing or understanding the forms, please call 740-845-8652, select the “new client” option and ask for assistance.
Review our Privacy Policies Here: Click Here
Review our Complaint Procedures Here: Click Here