The following forms should be completed and returned to us via fax (740-924-2002) or paper mail (9734 Jug St. NW Pataskala, OH 43062). Once we receive these forms we will contact you to schedule an intake appointment.
- Client Information Form
- Emergency Medical Treatment Form
- Insurance Billing Form
- Fees and Scholarships
The facilities where we deliver our services require liability waivers in addition to those forms required for program admission. Please check with us to determine which of these waivers you are required to complete.
- Otterbein University Liability Waiver – Minor
- Otterbein University Liability Waiver – Adults
- Ohio State University Liability Waiver
These two forms should be completed if they are applicable to your situation.
Here is some additional information on our treatment and privacy policies. These forms will be provided at your intake appointment.