For Scheduled Appointments, please fill out forms below.
These forms can be

• emailed to office@hcccares.com;
• mailed to PO Box 24242 Cleveland, Ohio 44124;
• or sent to our confidential fax at 216-896-0735

Adult Forms

Adult Authorization for release of Information
Adult Intake
HCC Financial New
HIPAA
Informed Consent for Telehealth
Insurance Card
Patient Consent Form
Patient Rights

Child & Adolescent Forms

Authorization for release of Information
Child and Adolescent Intake
Divorced Financial Agreement – if applicable
HCC Financial New
HIPAA
Informed Consent for Telehealth
Insurance Card
Patient Consent Form
Patient Rights