Client Forms SIMS Foundation

Client Forms

New Clients:  In order for us to complete your enrollment as a SIMS client and refer you to appropriate care, you will need to complete both of these forms and press ‘save’ in the upper right corner of the page.

Annual Rauthorization Clients:  You need complete ONLY form number 2; Informed Consent–Statement of Income and Residency, and click “save.”

All SIMS-sponsored services require a copayment; in order for us to fairly assess your copayment, you must provide a statement of your total household adjusted income from all sources (this is shown on line 37 of your tax return).

If you are a HAAM client, the income you report to SIMS should be the same as you reported (and verified) to HAAM.

Also, please remember to upload a scanned image of your driver’s license.  If the address on your driver’s license is not current, you may upload another document containing your residential address such as a telephone or utility bill.

Please begin here by filling out both forms if you are a NEW Clients, and ONLY 2) SIMS Consent Forms if you are an established client:

1) Client Intake Form

2) SIMS Consent Forms