Forms and Links you Need

This page contains documents that you will need when doing business with us. They are both in DOCX or DOC (Word for Windows) and in PDF (Adobe Acrobat) format. A free Acrobat Reader is available here. If you have a Mac computer, you may need to use the PDF version. 

Forms all clients will need:

Service Agreement (DOCX)                                        Service Agreement  (PDF)

Release of Information (DOC)                                  Release of Information (PDF)

(This release form is not HIPPA Compliant.  It is for use only to authorize release of information held by FamilyLight. FamilyLight is not subject to the HIPPA law.)

Check list for home Visit (DOC)                               Check list for home Visit  (PDF)

FLFactSheet (DOC)                                                         FLFactSheet  (PDF)

Forms some clients will need:

HIPPA Compliant Authorization to Release Confidential Information (PDF)

Pay for Services by Credit Card, Debit Card or PayPal  (This is not for membership in FamilyLight "members only" website. For that purpose go to FamilyLight Member Area)

The following form is obsolete unless you are authorizing us to use your credit card to charge an expense (usually an airline ticket):

Credit Card Authorization (DOC)                       Credit Card Authorization (PDF)

These forms were all created for and by FamilyLight, except the HIPPA Compliant Release and the page for making credit card payments to us through PayPal. The page for processing payments through PayPal was created by DG Design.

Fax papers to 775-890-0597 or scan and email to tcroke at familylight dot com or send hard copy to 11 Torrington Drive, Greensburg, PA 15601.

Required signatures must be signed by hand, not using computer signatures.  The signed documents may be faxed, scanned and emailed, snail mailed, overnighted, or hand delivered.

Please read our full disclaimer. You are responsible for verifying our information before acting on it.

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Archived "Forms you will need" from Old Format Pages

Last Update July 8, 2016

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