Downloadable Forms

Please Fill Out The Required Forms

Intake Forms for Adult Clients

Adult Patient-Provider Agreement HIPAA Patient Demographics Summary of Important Information for KOKO Clients PHQ-9 Screen GAD-7 Screen Primary Care Intake Form/Patient Demographics Form Behavioral Health Intake Form Womens Health Form - Established Patient Packet Womens Health Form - New Patient Packet

Intake Forms for Youth Clients

Child Patient-Provider Agreement Patient Questionnaire - Child Form HIPAA Patient Demographics Summary of Important Information for KOKO Clients New Born Visit Questionnaire Pediatric Medical History

Miscellaneous Forms

Sliding Fee Discount Program Application Sliding Fee Schedule Sliding Fee Discount Program Policy/Procedure Application for Reinstating KOKO Services Consent to Release Information Form Volunteer Agreement and Code of Conduct Form Behavioral Health Intake