THE COLLABORATIVE GR
  • Home
  • About Us
    • Services
    • Location
  • Practitoners
    • Katie Padron, LMSW
    • Cristina Stauffer, LMSW
    • Stacey Figg, PCD (DONA)
    • Omar Flores, LMSW, CAADC
    • DeWanda Gichemi, LMSW
  • New Patients
    • Forms
  • Contact

Forms

Please print and complete the forms for your specified practitioner.
Bring with you to your intake appointment. 

Forms to Complete:
  • The Intake Form for your specified age range​
What to Bring:
  • Form of Identification
  • Insurance card(s)

Katie Padron, LMSW

Intake_Child Ages 12 & Under
File Size: 254 kb
File Type: pdf
Download File

Intake_Adolescent Ages 13-17
File Size: 283 kb
File Type: pdf
Download File

Intake_Adult Ages 18 & Up
File Size: 279 kb
File Type: pdf
Download File

Cristina Stauffer, LMSW

Intake_Adolescent Ages 13-17
File Size: 638 kb
File Type: pdf
Download File

Intake_Adult Ages 18 & Up
File Size: 837 kb
File Type: pdf
Download File


DeWanda Gichemi, LMSW

dewanda_-_adult_intake.docx.pdf
File Size: 135 kb
File Type: pdf
Download File

dewanda_-_adolescent_intake__ages_13-17_.docx.pdf
File Size: 135 kb
File Type: pdf
Download File

dewanda_-_child_intake__ages_12_and_under_.docx.pdf
File Size: 113 kb
File Type: pdf
Download File

We Would Love to PARTNER IN YOUR CARE!

  • Home
  • About Us
    • Services
    • Location
  • Practitoners
    • Katie Padron, LMSW
    • Cristina Stauffer, LMSW
    • Stacey Figg, PCD (DONA)
    • Omar Flores, LMSW, CAADC
    • DeWanda Gichemi, LMSW
  • New Patients
    • Forms
  • Contact