Client Forms

Prodigal Kids

Client Portal & Forms (Online)

Client forms may be submitted online or downloaded and faxed to the office. To access the New Client Registration Forms, click here. Before you complete each form, please make sure to read each set of instructions. Once you have completed these forms, you may submit online or download and bring to your first appointment. Intake paperwork must be entirely filled out prior to beginning services. Incomplete or missing information may result in a rescheduling or canceling of the initial intake. If you are a parent, legal guardian, court-appointed guardian or have power of attorney, you are responsible for completing the paperwork for individuals under the age of 18.

Client Forms

Step 1. Client Facesheet

This form gathers the most current demographic information on file for your record only. Please make sure that information entered is up-to-date. To begin click here.

Step 2. Service Agreement

Please read the entire document before signing as it pertain directly to the services rendered at Prodigal Kids Behavioral Health Services. To begin click here.

Step 3. Client Rights and Responsibilities

It is of the utmost importance to us that you are fully aware of your rights and responsibilities as our client before services are rendered. To begin click here.

Step 4a. Child and Adolescent Information

If the new client is 17 or younger (minimum age: 5 years old) please complete this form. To begin click here.

Step 4b. Adult Client Information

If the new client is 18 and older please complete this form. To begin click here.

Authorization to Release Protected Health Information

If there is a third party involved in your treatment (or your child’s treatment) with whom it would be helpful for Prodigal Kids to communicate (e.g. school guidance counselor, primary care physician, previous counselor, other family members or supports, etc.), it is your choice if you would like to authorize us to exchange information with that individual or organization. Please fill out as many of these forms as needed and give them to your assigned counselor.