Client Intake Form

DSPC is excited to start the process of finding a DSP for you and your family.

Please fill out the intake form and a Connection Team member will reach out within a few business days to complete the process. The team member will ask a few additional, in-depth questions to help aid in finding the appropriate DSP for your family. DSPC looks forward to learning more about you and your family’s needs and how we can serve those needs.

Client Intake - codys interview 480
Person Completing This Form
Parent / Guardian
County
Individual Receiving Services
Case Manager
Additional
By submitting this form I understand that I am authorizing the following: *DSP Connections to contact me about services. *For DSP Connections 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 connections@dspconnections.org.