Intake Form | Lifting Adults with Guidance

Forms

Please fill out the forms below within step 1 & 2 and email them to:

If you have any questions, please call us at:

The intake form is the first step for acceptance into Lifting Adults with Guidance Day Habilitation Program.
Intake Form
Please include the following documents with your Acceptance Information:

Guardianship Paperwork if it applies

Individual Picture ID

Insurance Card/Medicaid Card

Essential documentation for Lifting Adults with Guidance Acceptance.
1. HIPAA Authorization to Disclose Information
2. Participants-Rights-Responsibilitie
3. Emergency Consent
4. Transportation Sign Off
5. Weight Release
6. Photo Release
7. DDD Medical Form
8. OTC Form

Lifting Adults with Guidance is a licensed DDD approved Day Habilitation Program servicing New Jersey.

LIFTING ADULTS