Intake Packets

Intake Packets

Please turn completed intake packet in to The Carruth Center prior to your child's first session. Packets may be dropped off, emailed or faxed to (713)935-0654. Please contact Jessica Hoang or Virginia Dietz for more information.

Each program intake packet contains:

  • Case History
  • Authorization for Emergency Medical Attention
  • Consent for Treatment
  • Payment Contract
  • Authorization for Request/Release of Information
  • Fee Schedule