Get Started at The Southfield Center

Child/Adolescent Intake Form
Insurance Preauthorization Form
HIPAA Privacy Notice
Consent to Release or Obtain Information
Adult Intake Form

These forms need to be completed prior to the first Intake session. Please click on the applicable form as noted in the email from the Intake Coordinator. The form will launch a WORD document which can be completed and saved to your computer.

PLEASE SEND ALL COMPLETED DOCUMENTS TO forms@southfieldcenter.com 24 HOURS PRIOR TO THE FIRST INTAKE APPOINTMENT.