Client Doc Uploads

Secure Document Upload

Please use this HIPAA compliant form to upload documents requested by staff.
Submission Date*

MonthDayYear
Date
Client Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
We require the following forms prior to moving in.
- Client photo
- Proof of COVID-19 vaccine (minimum 1 dose)
- Copy of ID (front and back)
- Proof of negative COVID-19 test performed within 48 hours of move-in
If available please provide the following:
- Proof of Insurance
- Proof of Income
- Proof of tribal affiliation
File Upload Option (use for file upload instead of camera)

Cancelof
Required, Client Photo
Required, Proof of COVID-19 Vaccine
Required, Front of ID
Required, Back of ID
If applicable, Front of Insurance Card
If applicable, Back of Insurance Card
If applicable, Proof of Income
If Applicable, Proof of Tribal Affiliation
Should be Empty:

Secure Document Upload