Cohen Clinic at Easterseals: Client Forms

Client Forms

*These forms are for review purposes. Electronic forms will be sent to you to complete after an appointment has been made.

Adults

1. Adult Intake Packet
2. Adult Informed Consent
3. Adult Client Rights and Responsibilities
4. Adult Consent Form for the Sharing of User Information
5. Adult Authorization to Bill Form
6. Adult CCC Fund Asst Form
7. Adult DVBIC
8. Adult QLES
9. Adults PCL5
10. Adult CSI-4

Children

1. Child Intake Packet
2. Child Informed Consent
3. Child Client Rights and Responsibilities
4. Child Consent Form for the Sharing of User Information
5. Child Authorization to Bill Form
6. Child CCC Fund Asst Form
7. Child CIS Parent