| | | info@safechildnc.org | 919.743.6140

  • HOME
  • ABOUT US
  • PROGRAMS & GROUPS
  • PARENT RESOURCES
  • HOW TO HELP
  • REPORT CHILD ABUSE
  • LE/CPS REFERRAL
Logo Logo Logo Logo Logo
Logo
Register for a program or group Donate to SAFEchild
  • About Us
  • Find a Program or Group
  • Donate to SAFEchild
  • Parent Resources
  • How to Help
  • Report Child Abuse
  • About Us
  • Find a Program or Group
  • Donate to SAFEchild
  • Parent Resources
  • How to Help
  • Report Child Abuse
Intake Forms/Formularios de Ingreso

English

1 / Welcome form

2 / Consent for treatment

3 / Authorization for release of information

4 / Notice of disclosure of information

5 / Consent for release of medical information

6 / HIPAA notice of privacy practices

7 / Family needs and services

Español

1 / Documento de bienvenida

2 / Consentimiento para el tratamiento

3 / Autorización para divulgar la información

4 / Aviso de divulgación de la información

5 / Consentimiento para la divulgación de información

6 / Aviso a los pacientes sobre nuestras prácticas de privacidad

7 / Necesidades y servicios familiares

SAFEchild
919.743.6140
864 West Morgan Street
Raleigh, NC 27603

 

SAFEchild Advocacy Center
919.231.5515 (phone)
919.231.5516 (fax)

2815 Kidd Road
Raleigh, NC 27610

 

Join SAFEchild's email list!
We send updates periodically and would love to add you to our email list!
=
Search SAFEchild’s site

Home

About Us
Board
Staff
Corporate Partners
Young Ambassadors

Register for a Program or Group

 

Programs and Groups
Moms Supporting Moms
MOVE
Circle of Security
Crianza con Cariño
MENS
Funny Tummy Feelings
SAFEchild Advocacy Center

Growing Resilience Movement

Report Child Abuse

 

LE/CPS Referral

 

How to Help
Donate to SAFEchild
Volunteer
Wish List

Parent Resources

SAFEchild News

Contact Us

 

©2022 SAFEchild
Privacy Policy | Send an email
  • Español