Client Intake

A Medicaid Agency That Cares Like Family

We are currently at capacity and are not accepting new clients.

Client Intake

A Medicaid Agency That Cares Like Family

We are currently at capacity and are not accepting new clients.

Client Intake Form

  • MM slash DD slash YYYY
  • CASE MANAGER CONTACT INFORMATION

  • By submitting this form I understand that I am authorizing the following: *Out Of The Box Solutions to contact me about services. * Out Of The Box Solutions to share any pertinent information, history, and documentation with the Direct Support Professional that I have selected to provide services so that they are educated on the care that is needed. I understand that I may revoke this approval to share information by emailing [email protected].