Optional - Printable Client Medical Documentation Form

If you would like a hard copy or an editable PDF of our Client Medical Documentation Form to send to us via fax or scan to us via email, please use one of the forms provided below. 

 
 
 

 

 

Printable Client Mediacl Documentation
BHIC Medical Documentation Form.docx
Microsoft Word document [23.0 KB]

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© Blake's House of Independence 1135 A Shallowford Rd Marietta, GA 30066 Phone: 678-767-2865