INTAKE FORMS

Welcome to North Coast Family Foundation’s secure patient forms. You can fill out these secure forms right here online and submit them directly to our office. New Patients please start the PATIENT FORMS PACKET from start to finish. The single forms listed are available if the need arises to fill out a specific form.


We recommend that you call your insurance company to inquire about your plan’s benefits for outpatient mental health services done in an office setting. Ask for your customer care representative.


As a courtesy, NCFF can do this for you as well.


PATIENT FORMS PACKET

Here are the links for individual NCFF Intake forms:

INFORM YOUR PHYSICIAN

FINANCIAL POLICY

NEW CLIENT INFORMATION

NEW CLIENT INFORMATION PT2

PATIENT REGISTRATION

PRACTICE PRIVACY STATEMENT

PRIVACY CONSENT

PRACTICE PRIVACY STATEMENT PT2

ELECTRONIC SERVICE DELIVERY INFORMED CONSENT

CREDIT CARD PAYMENT AUTHORIZATION FORM