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Copyright (c) 2007 North Central Ministry Development Center
.:Client Registration
These forms are on a secure site; all information submitted is confidential.
North Central Ministry Development Center
Copyright (c) 2005 North Central Ministry Development Center
Releases of Information:
Policy on Use of Client Data in Research
Limits of Confidentiality
Statement of Personal Conduct
To fill out and submit a form on the web, click the link corresponding to the form's name.
To download a printable form to send in via mail, click on the Word icon (for a Word document) or the Adobe icon (for a PDF document) next to the form.
A word of caution: if you are unable to finish the online form in one sitting, just saving the web page won't capture the text you have written, so you will have to copy and paste your answers into a document to save. It might be best to write up answers in a document to begin with, then copy and paste them over once every question has been answered.
Welcome to our Center. Please carefully read this entire page before proceeding. If you are just beginning the process as a client, please fill out the first form on the list: "Registration for Individual Program". After that is submitted we will call you to schedule your program.
Medical History (Part B) - This needs to be completed by a physician
