Logo

Domestic Violence Therapeutic Group Intake Checklist

Document Name
Participant Initials
Staff Initials
Iris Family Support Center's Vision, Mission, and Beliefs
Notice of Privacy Practices
Participant Rights and Responsibilities
Grievance Procedures
Consent for Services
HIPAA Privacy Receipt Acknowledgement
Consent to Release & Request Information
Consent to Communicate
DVTG Assessment
DVTG Participant Contract
DVTG Group Rules
UNCOPE Screen
Aftercare Plan
Complete Demographics in CaseWind

By signing below, I acknowledge that I have received and reviewed the above documents.


Clear Signature
Clear Signature
Clear Signature
Client Signature
Client Signature
Staff Signature