Client Forms

Complete these forms before your first appointment to save time when you arrive.

Child

Click on the link below and follow the directions to submit the form.

Client Information Form 

Intake Questionnaire – Child 

Credit Card Authorization Form

If you would like Back on Track to communicate or send documentation to another person or organization a Release of Information must be signed.  You can print and sign the document from the link below.  Either fax the completed and signed request to 866-405-5789 or email it to info@wearebackontrack.com.

Release of Information

Adult

Click on the link below and follow the directions to submit the form.

Client Information Form 

Intake Questionnaire – Adult

Credit Card Authorization Form

We look forward to serving you!

Miscellaneous Forms

Authorization for the Release of Information

Document Request