Attachment Disorder

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Application Packet

Our attachment services are initiated with the completion of an application packet. We believe that a thorough evaluation requires information. Thus, the packet is our way of ensuring that your services at Adoption and Attachment Therapy Partners LLC are initiated with a solid understanding of your unique situation.

Complete packets or individual application packet documents are accepted by regular mail. Our address is : Arleta M. James, LPCC, Adoption and Attachment Therapy Partners, 1201 Canyon View Road Sagamore Hills, OH 44067.

If you have any questions, please call 330.813.2525.

You will need to have the Adobe Acrobat Reader installed on your computer to view PDF files.

All of the following sections are required to complete your application:

Child Registration Form
Financial Agreement
Permission to Treat
Child History Report
Parent Autobiography
Notice of Privacy Practices and Consent to Use and Disclose Your Health Information
Full Application

Please include the symptom checklist appropriate for your son or daughter’s age:

Attachment Symptoms for Children Under 5
Attachment Symptoms for Children Over 5