COMMONLY USED FORMS

  National Institute for Change has been in business since 2003  

Below are our most common forms. 

Don’t see what you’re looking for?

Contact change@nichange.com and we will gladly assist you.

TELEHEALTH DISCLOSURE, please complete and email to either your clinician or change@nichange.com.

LEVEL B GROUP SCHEDULE, for virtual groups.

NIC WELCOME PACKET, used for all first-time appointments and for clients who have gone more than 6 months since their last appointment.

RELEASE OF INFORMATION

SLIDING SCALE APPLICATION, application to lower the cost of on-going treatment. Does not apply for intakes or evaluations.

CLINICIAN CONTACT INFORMATION