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DocuSign Envelope ID: 134EF964467E4B598FBE38938807B2CCHealth Questionnaire CIS Emotional and physical health go together in children. Because parents are often the first to notice a problem with their
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To fill out the Cohen Clinic at Easterseals form, follow these steps:
02
Visit the official website of the Cohen Clinic at Easterseals.
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Look for the 'Forms' section on the website.
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Click on the link to download the 'Cohen Clinic Intake Form'.
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Open the downloaded form using a PDF reader.
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Fill in your personal information accurately, such as your name, address, and contact details.
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Answer all the questions on the form to the best of your knowledge.
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Save a copy of the filled-out form on your device.
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Submit the form by either printing and mailing it to the Cohen Clinic at Easterseals or by uploading it on their website.
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Wait for a response from the clinic regarding your intake form.

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The Cohen Clinic at Easterseals is designed to provide mental health services to individuals who meet the following criteria:
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- Military veterans
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- Active duty service members
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- National Guard and Reserve members
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- Their families (spouses, children, parents, siblings, etc.)
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- Individuals who have experienced any trauma related to military service
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- Individuals struggling with mental health issues such as anxiety, depression, post-traumatic stress disorder (PTSD), etc.
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If you or someone you know falls under any of these categories and requires mental health support, the Cohen Clinic at Easterseals can be a valuable resource.
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Cohen Clinic at Easterseals provides high-quality, accessible, and integrated mental health care services for post-9/11 veterans and military families.
Any post-9/11 veteran or military family member seeking mental health care services can file for Cohen Clinic at Easterseals.
To fill out Cohen Clinic at Easterseals, individuals can visit their website or contact the clinic directly to schedule an appointment and start the intake process.
The purpose of Cohen Clinic at Easterseals is to provide mental health care services specifically tailored to the needs of post-9/11 veterans and military families.
Individuals may need to provide personal information, medical history, insurance details, and any other relevant information for their mental health care treatment.
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