Social Emotional Screening
Printable forms to take to your healthcare providers
Additional Enrollment Form Packet
This packet contains four additional forms required for enrollment.
• Consent – Rights and Responsibilities
• Release Authorization
• ETA -Emergency Transportation Authorization
• Health History
You can complete the packet and either email it to firstname.lastname@example.org or print the forms and bring them to your intake appointment with your child’s proof of age; your proof of residency; your child’s immunization history; and proof of income for the last 12 months.
Transportation Request Forms
Adobe Reader may be required for these forms, it can be downloaded here https://get.adobe.com/reader/ or from your app store for your smart phone.