CFPA LLC

822 Portage Trail

Cuyahoga Falls, OH 44221

cfpaportage@outlook.com

For Life-Threatening Emergencies Call 911

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Intake Forms/Release of Information

Below are the intake forms that will need to be completed at the initiation of services.  You may chose to print and complete and then bring them with you to your first session by clicking on the links below.  Please note that we will also need to obtain a copy of the front and back of your insurance card at the time of your first appointment.  


 

Adult Intake Packet- for adults 18 and over.

Adolescent/Child Intake Packet- for children and adolescents (under 18).  To be completed by a legal guardian.

The Testing Agreement details the process and financial understanding for psychological testing.

The Release of Information Form only needs to be completed if there is someone you would like us to communicate with.  This can include teachers, physicians, etc.  Please note that authorization for a release can be completed or withdrawn at any time.