Case History Credit Card Form (coming soon) Authorization for Emergencies Release of Information Forms_files/Carruth%20Case%20History.pdfhttp://www.carruthcenter.org/pdf/Forms/Emergencies.pdfhttp://www.carruthcenter.org/pdf/Forms/ReleaseofInfo.pdfshapeimage_4_link_0shapeimage_4_link_1shapeimage_4_link_2

If you are a person who likes to plan ahead, this is the page for you. Download forms so that you can have them filled out prior to your visit.

Forms

 Speech-Language and Occupational Therapy Fee Schedule SLP-A fee schedule Psychological Services Masters Level Doctoral Level Court Retainer -- please contact Clinical Director Nicole Devens Forms_files/Speech%20OT%20Fee%20Schedule.pdfForms_files/Speech%20OT%20Fee%20Schedule.pdfForms_files/SLP%20A%20fee%20sched.pdfForms_files/Psych%20Masters%20Fee%20Sched.pdfForms_files/Fee%20Schedule.pdfshapeimage_5_link_0shapeimage_5_link_1shapeimage_5_link_2shapeimage_5_link_3shapeimage_5_link_4



Consent for Treatment: specific to service or clinician

Payment Contract:  specific to service or clinician

Financial Designation: if requesting/utilizing a third party to assist with payments (i.e. Grandparents or other relatives)

 
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