The Gentle Shepherd
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Child Intake Forms 

Please fill out the attached forms that apply to you and download them to your device. Once finished you may send them to info@gsccohio.com or call our main office at 330-499-3065 if you need assistance.
Child Consent 2022
File Size: 108 kb
File Type: pdf
Download File

Child History Form 2022
File Size: 251 kb
File Type: pdf
Download File

Policies and Procedures
File Size: 546 kb
File Type: pdf
Download File

Health Insurance 2022
File Size: 524 kb
File Type: pdf
Download File

Release of Information 2022
File Size: 155 kb
File Type: pdf
Download File

Self Pay Form
File Size: 213 kb
File Type: pdf
Download File

Telehealth Consent 2022
File Size: 202 kb
File Type: pdf
Download File

Late Cancel Payment
File Size: 136 kb
File Type: pdf
Download File

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  • Home
  • CLINICIANS
  • About
  • FAQ
  • New Client Forms
    • Adult Forms
    • Adolescent Forms (13-17)
    • Child Forms (12 and Below)
  • Contact
  • Intake Scheduling