AKRON FAMILY INSTITUTE

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    Initial Intake Documents

    To Fill Out:

    Initial Intake Forms
    Consent for Treatment
    Health History Questionnaire
    Financial Responsibility Form

    To Read:

    Client Rights and Responsibilities
    Telehealth Informed Consent
    HIPAA
    Client Information Form
    Authorization for Release

    Phone: 330-644-3469

    Fax: 330-644-8519

    3469 Fortuna Drive, Akron, OH 44312