COMMONLY USED FORMS

  National Institute for Change has been in business since 2003  

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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.

RE-ENROLLMENT PACKET, for clients returning to NIC after 30 days to 6 months without services.

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

About

National Institute for Change has been providing therapeutic services since 2003. Our multiple locations and experienced staff provide options to meet your needs using motivation interviewing, helping identify and support wherever clients are in their change process.

We are committed to collaboration and serving clients and families with a meaningful balance of challenge and encouragement, using
state-of-the-art therapies.

© 2020 National Institute for Change | email: change@nichange.com

 Working Hours​

  • Monday 9:00am - 5:00pm

  • Tuesday 9:00am - 5:00pm

  • Wednesday 9:00am - 5:00pm

  • Thursday 9:00am - 5:00pm

  • Friday 9:00am - 5:00pm

  • Saturday CLOSED

  • Sunday CLOSED