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Home » Departments » Branford Counseling & Community Services » Client Forms

Client Forms

New Clients

  1. New Client Form
  2. Photo ID and Insurance Card Upload
  3. Welcome Packet
  4. Consent to Treatment
    1. Consent for Treatment of Minors (under 18)

All Clients

Authorization for Use and Disclosure of Protected Health Information

Informed Consent to Telehealth

Medication Evaluation and Management Programs

Notice of Privacy Practices (revised 10/2019)

Updox Patient Portal Consent and Authorization

Auxiliary Fields

Branford Counseling & Community Services

Last Updated: Tue, 10/04/2022 - 2:40pm

Branford Counseling & Community Services Resources

Persons
Executive Director Peter Cimino, M.S., L.P.C.
Phone:
(203) 481-4248
Fax
(203) 483-7727
Address
342 Harbor St.
Branford, CT 06405
Operating Hours
9AM - 5PM Monday - Friday
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Department Directory

Department Links

Branford Coalition to Prevent Underage Drinking
Branford Social Services
COVID-19 Programs
Information for Parents
Resource Guide

Town Hall

1019 Main Street
Branford, CT 06405

(203) 488-8394

Monday - Friday
8:30AM - 4:30PM
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  • Home
  • Government
    • Town Hall
      • Staff Directory
      • Board of Selectmen
      • Document Center
      • First Selectman
      • Latest News
      • Probate Court
      • Fiscal Year Budgets
      • Town Charter
    • Departments
      • All Departments
      • Animal Shelter
      • Building & Inspection
      • Human Resources
      • Town Engineer
      • Public Works
      • Parks & Recreation
      • Public Libraries
    • More Departments
      • Registrar of Voters
      • Senior Center
      • Solid Waste & Recycling
      • Sustainability and Compliance Office
      • Tax Collector
      • Town Clerk
      • News & Announcements
    • Boards and Commissions
      • All Listings
      • Minutes & Agendas
      • RTM
      • Meeting Schedule
      • Public Meeting Videos
      • Notices - Boards, Commissions, Committees
  • Services
    • Online Services
      • GIS
      • Ecode 360
      • Land Records
      • Pay/View Taxes
      • Pay for Building Permit
    • Resources
      • Affirmative Action Policy
      • Bids and RFPs
      • Employment Opportunities
      • Fair Housing Policy
      • Holiday Closures
      • News and Events
      • Senior Center
      • Sustainability and Compliance Office
    • Pay a Bill
      • Sewer Use Bill
      • Taxes
  • Community
    • Residents
      • Calendar
      • Counseling Center
      • Dog Licensing
      • Emergency Interest Free Loans
      • Energy Assistance (PDF)
      • Jazz on the Green
      • Marriage/Birth/Death Certificates
      • Public Libraries
      • Public Schools
      • Public Utilities
      • Recreation and Parks
      • Registrar of Voters
      • Recreational Shellfishing
      • Senior Center
      • Veterans Affairs/Resources
    • Public Safety
      • Animal Control
      • Code Red-Branford Alerts
      • Emergency Management
      • FEMA Flood Insurance Maps
      • Fire Department
      • Health Department
      • Police Department
    • About Branford
      • History
      • Directions (GPS map)
      • Contact Us
      • Organizations & Services
      • Walking Trails
  • Business
    • COVID-19 Temporary Outdoor Dining info
    • Business Owner Resources
      • Chamber of Commerce
      • Commercial Building Sites
      • Commercial Properties
      • Reports & Publications
      • Small Business Administration
      • Land Records
    • Doing Business
      • Discover Branford!
      • Economic Development
      • Employment
      • RFP's and Bids
      • Start Your Business
    • Local Businesses
  • How Do I...
    • Find
      • Contact Us
      • FAQs
      • Animal(s) for Adoption
      • Holiday Closures (calendar)
      • Public Libraries
      • Recycling information
      • School Information
      • Senior Center Programs
      • Town Charter
      • Where to Vote
    • Request
      • Beach & Transfer Station Stickers
      • Birth Records
      • My Tax Information
      • Vital Statistics
    • Submit
      • Early Voter Registration
  • Home
  • Government
    • Town Hall
      • Staff Directory
      • Board of Selectmen
      • Document Center
      • First Selectman
      • Latest News
      • Probate Court
      • Fiscal Year Budgets
      • Town Charter
    • Departments
      • All Departments
      • Animal Shelter
      • Building & Inspection
      • Human Resources
      • Town Engineer
      • Public Works
      • Parks & Recreation
      • Public Libraries
    • More Departments
      • Registrar of Voters
      • Senior Center
      • Solid Waste & Recycling
      • Sustainability and Compliance Office
      • Tax Collector
      • Town Clerk
      • News & Announcements
    • Boards and Commissions
      • All Listings
      • Minutes & Agendas
      • RTM
      • Meeting Schedule
      • Public Meeting Videos
      • Notices - Boards, Commissions, Committees
  • Services
    • Online Services
      • GIS
      • Ecode 360
      • Land Records
      • Pay/View Taxes
      • Pay for Building Permit
    • Resources
      • Affirmative Action Policy
      • Bids and RFPs
      • Employment Opportunities
      • Fair Housing Policy
      • Holiday Closures
      • News and Events
      • Senior Center
      • Sustainability and Compliance Office
    • Pay a Bill
      • Sewer Use Bill
      • Taxes
  • Community
    • Residents
      • Calendar
      • Counseling Center
      • Dog Licensing
      • Emergency Interest Free Loans
      • Energy Assistance (PDF)
      • Jazz on the Green
      • Marriage/Birth/Death Certificates
      • Public Libraries
      • Public Schools
      • Public Utilities
      • Recreation and Parks
      • Registrar of Voters
      • Recreational Shellfishing
      • Senior Center
      • Veterans Affairs/Resources
    • Public Safety
      • Animal Control
      • Code Red-Branford Alerts
      • Emergency Management
      • FEMA Flood Insurance Maps
      • Fire Department
      • Health Department
      • Police Department
    • About Branford
      • History
      • Directions (GPS map)
      • Contact Us
      • Organizations & Services
      • Walking Trails
  • Business
    • COVID-19 Temporary Outdoor Dining info
    • Business Owner Resources
      • Chamber of Commerce
      • Commercial Building Sites
      • Commercial Properties
      • Reports & Publications
      • Small Business Administration
      • Land Records
    • Doing Business
      • Discover Branford!
      • Economic Development
      • Employment
      • RFP's and Bids
      • Start Your Business
    • Local Businesses
  • How Do I...
    • Find
      • Contact Us
      • FAQs
      • Animal(s) for Adoption
      • Holiday Closures (calendar)
      • Public Libraries
      • Recycling information
      • School Information
      • Senior Center Programs
      • Town Charter
      • Where to Vote
    • Request
      • Beach & Transfer Station Stickers
      • Birth Records
      • My Tax Information
      • Vital Statistics
    • Submit
      • Early Voter Registration
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