Client Eligibility Form (Adolescent IOP)
Once completed our Clinical Intake Specialist, Katie Frits, will be in contact within one business day to schedule an in-person assessment. If you have any trouble with this form call Renew at 913.768.6606 and press 0. At the assessment we will provide you a written review of your insurance benefits and out-of-pocket costs.
Next
Never submit passwords through Google Forms.
This form was created inside of Renew Counseling Center. Report Abuse - Terms of Service