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.
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.
Adult
Click on the link below and follow the directions to submit the form.
HIPAA and CONFIDENTIALITY INFORMATION
Click on the link below and DOWNLOAD the form. Complete and sign the form and bring with you to your first appointment. This form must be turned in with original signatures and cannot be scanned and emailed back. If you do not bring this form with you, one will be provided when you arrive.
Agreement to Enter into Counseling Services
We look forward to serving you!
Miscellaneous Forms
Authorization for the Release of Information