Clinic Forms

Assessment and Intake Forms

The KU Child and Family Services Clinic has moved many of its assessment and intake forms to a secure online format. If you have questions about which forms to complete, please call the Clinic. We will be happy to help you.

The button below is for those who have completed a phone screen with a clinic associate or are current clients in the KU Child and Family Services Clinic. Please do not access these forms unless one of our associates has asked you to do so.

CLINIC FORMS - COMPLETE AFTER PHONE SCREEN

For Your Records Only

The following PDFs are provided for your records only. All forms should be completed online through the link above.

Notices

Notice of Privacy Practices (pdf)
Notice of Privacy Practices Signature Page (pdf)
Fee Policy (rev. 2022) (pdf)

Consent Forms

Consent for Assessment and Treatment (Child Client) (pdf)
Consent for Assessment (Adult Client) (pdf)
Consent for Telehealth Services (pdf)
Consent for Research Participation (pdf)
Parking Policy/Consent Form (pdf)
Release of Information (pdf)

Clinical Measures

Parent Intake Questionnaire (pdf)
CEMS Parent Report (pdf)
Disruptive Behavior Disorders Scale (pdf)
Proactive and Reactive Aggression Questionnaire (pdf)
RCADS-47 (pdf)