Other CCPC-Ohio Forms
Other CCPC-Ohio Forms

Please go to our Therapist page, download (their) forms and complete the intake paperwork.
Bring both the completed intake paperwork and the fee
agreement to your first appointment.

These forms require Adobe Reader to View - Click Here

NOTE: The forms may be password protected.
Depending on your web browser, you may have to download the forms first,
then open the files. On the links below, right click your mouse, select (Save target as ...)
save the files to your desktop, then open the files using the provided the password.

Client Authorization for Release of Information
CCPC-Ohio Directions to Our Offices
Information and Questions About Insurance Benefits and Eligibility

NOTE: The Outpatient TRICARE Service Request form is only used for services through TRICARE where the therapist is a PCC (Professional Clinical Counselor) It is used when requesting authorization or referral for outpatient health care services.

Outpatient TRICARE Service Request-Notification Form

Copies of Individual Forms TOP OF PAGE