Online Intake Form

Two Options to Complete our Client Intake Form

Complete our Client Intake Form electronically or print the PDF version, complete it and send it back to us with the associated documentation.

Online Client Intake Form

Below is a mult-step online form. There are 12 different sections and you must complete each section before moving on to the next. Make sure to complete the form, sign it, and submit it all in one sitting. We highly recommend using the Chrome Browser. If you do not use Chrome, you may want to download the PDF version.

Printable PDF Client Intake Form

Uncomfortable completing this form online? You may use our downloadable PDF form instead: Client Assessment & Consent Form. Please print and fax your completed form to 724-532-0701, along with required documentation. Completed materials may also be mailed to us.