PLEASE EMAIL COMPLETED FORMS TO: [email protected] . If any difficulty sending forms call CAFTACS Director of Services Steve Mowers at (585) 765-5041. Forms need to be returned electronically and not brought in to session on paper.
Required Forms
- If under Age 18 Child And Adolescent Intake Questionnaire - Parent Form
- If 13-22 Adolescent / Young Adult Self Report Form
- If over 22 Adult Personal History
- Consent for Release Pediatrician Office - NEW FORM, must be completed
- Consent for Release School District - NEW FORM, must be completed
- Consent for Release Discretionary - NEW FORM, must be completed
- HIPAA Notice Of Privacy Practices
- Patient Contract - NEW FORM, must be completed
- Credit Card Authorization Form
Optional Forms
