Intake Packet Forms:

Intake Assessment Form

Please read thoroughly and fill out entirely.

Both forms are fill-in and e-sign compatible! Adobe Reader must be set to default pdf viewer. Completed forms may be printed and brought to the first appointment, or they may be emailed to us at:  intake@andfc1.com

Contact Us

CENTRAL LOCATION: 1411 North Fairfield Rd. Beavercreek, OH 45432

SOUTH LOCATION: 8401 Claude Thomas Rd. Suite 37 Franklin, OH 45005

PHONE: 937.426.2686 (for ALL locations)

FAX: 937.426.6230

Click here to email

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