Intake Forms


Community Reach Center Intake Forms - Become a Patient - Woman holding pen signing agreement document

Welcome to Community Reach Center! Your first session with us is called an Intake assessment. Please click on What to Expect to understand what will take place at this meeting. We offer new admission meetings on a walk-in basis, 5 days a week from 8-2pm first come, first serve.

In preparation for your first intake meeting with us, please take a few minutes to download and complete the forms below. You may find it easier to complete these forms at home where you have all your information available. However, if you are not able to print these, forms will be available when you arrive at one of our offices. Forms are available in both English and Spanish.

Please bring an ID, insurance information, and financial information with you to walk-in intake or - if you prefer - a scheduled intake. If the client who is being assessed for services is under the age of 15 and you have either joint or primary custody, proof of legal guardianship must be presented at your intake assessment.

Please use a black ink pen to complete the form and do not fill in the date on the form until you arrive for intake.

Intake Forms—Adult English

Intake Forms—Child English

If you suspect your child has ADHD please fill out and bring to intake

Intake Forms—Adult Spanish

Intake Forms—Child Spanish

Si sospecha que su hijo tiene Trastorno de déficit de atención con hiperactividad (TDA/TDAH) complete y traiga a la primera cita de admisión

We look forward to seeing you soon!