Special Family Considerations

Special Family Considerations
At StarBright we want to respect individual family situations. Please take a moment to help us understand how your particular situation can impact your child’s treatment at our clinic.
Does your family/child have Spiritual/Cultural needs that we should consider? Please explain:
Does your family/child have specific medical family history needs that we should consider?
Does your family/child have legal considerations that we should be aware of? To include: custody, CPS, citizenship, and incarceration. Please explain:
Does your family/child have any other special considerations we should be aware of?
Child's Name*

First NameLast Name
Parent/Guardian's Name*

First NameLast Name
Should be Empty: