333 Dahlia Drive, Lansing, MI 48911
Hours of Operation:
Licensed Social Workers offer screening and assessment for a variety of behavioral health issues facing adolescents today. Comprehensive screening and assessments are available to individual patients at each of our Health Centers, and to members of the community.
Resources and Forms
Child and Adolescent Health Centers Brochure
Child and Adolescent Health Centers FAQ Sheet
Welcome to Ingham Community Health Centers! Below are many of the forms that you will encounter during your time as a patient with us. These forms allow us to treat you, receive or send your medical records, help you pay for care, and more. If you are interested in becoming a new patient, or need to update your information, please fill out the first form in the list.
Global Consent: This form gives your consent for treatment at our Health Centers, billing for services, and sharing of healthcare information in the event that you decide to receive behavioral healthcare with us.
Click here for our Global Consent Form.
This form captures all of the information that we need from you to establish care, or update your existing information with us. Click here
for our Registration Form.
Family Income Form:
This form allows us to determine if you are eligible for a discount on the healthcare you receive from us.
for our Family Income Form.
This form allows us to provide care for your child at one of our school-based or school-linked clinics.
for our Minor Consent Form.
Delegation of Consent to Treat Form
Medical Release Form (Medical Records)