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 Of Information - Complete one for Pediatrician, and one for School District
- HIPAA Notice Of Privacy Practices
- Patient Contract
- Credit Card Authorization Form
Optional Forms
- Alcohol Dependence Questionnaire
- Anxiety Symptom Questionnaire
- Drug Screening Questionnaire
- Eating Attitudes Questionnaire
- Depression Symptom Questionnaire
- Self Injury Questionnaire
- Suicide Behaviors Questionnaire
- Suicide Risk Assessment
