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adult intake form patient information
ADULT INTAKE FORM. PATIENT INFORMATION. Name: First. Last. Date of Birth ☐ Cant Sit Still. ☐ Leaves Seat. ☐ Interrupts Others. BEHAVIORAL PROBLEMS.
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Revised 9-1-21 i of i Intake Eligibility Application
Sep 1, 2021 Proof of Income must be provided at the time of the intake appointment. If the individual is under the age of 18, proof of the family income
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FAA Form 8710-1, Airman Certificate and/or Rating
The information collected on this form is necessary to determine applicant eligibility for airman ratings. We estimate it will take 30.
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