Center Intake

At Jacob’s Ladder, everyone is welcome, regardless of race, color, religion, gender, national origin, age, or if they have any mental or physical challenges. The information obtained in these intake forms is solely for informational purposes and will only be used to help determine the type and level of care to be provided.

New Beginnings for Our Familiar Faces

*First Steps families transitioning to outpatient services or previous patients who have not been seen for 12 months should fill out the "New Patient" intake.

New Patients

Complete our center intake form to begin your child's care journey with us.

Fill Out Intake Form

Current Patients

Fill out our existing patient intake form if your child is currently receiving treatment or is returning for additional care.

Fill Out Intake Form

JL Academy / Summer Camp

Complete the intake form to register for JL Academy or Summer Camp programs.

Fill Out Intake Form