Forms

Intake Forms

Our Client Handbook is designed to familiarize you with CHOICES, Inc., our mission, services, and to explain your rights and responsibilities.

Please, take some time to read and understand the contents of this document, then print and sign the Informed Consent Acknowledgement Form

Our New Client Registration must be completed by the applicant (or a legal guardian) in order to begin the enrollment process. The form gathers the most current demographic information, medical history, as well as reasons for seeking services with us. 

We ask that you complete as much of this form as you can. The more information you can provide, the quicker we can process your application. 

Confidentiality is very important to us. We hope that you will read over this information to familiarize yourself with our policies that protect your private health information. You will find an acknowledgement of receipt at the end. 

To determine your eligibility, or if there is another care provider involved in your care with whom it would be helpful for us to communicate, you may authorize us to exchange your protected health information (PHI) with that individual or organization. We are required to have this document signed to ensure our client’s confidentiality.

Before applying for services offered by CHOICES, Inc, please make sure to review eligibility criteria for each program and the types of services we can provide. 

OR

You may also contact CHOICES, Inc. at (907) 302 – 1925 and speak with our Intake Coordinator. This Individual will determine if we are suited to meet your needs.