Skip to content
Child and Family Agency

Child and Family Agency

Strong | Safe | Supported

  • Services
    • Counseling
      • Outpatient Care
        • Adult Outpatient Treatment
        • Open Access Hours
      • Community-Based Services
    • School-Based Health Centers
      • Enrollment
      • Where we Operate
    • Community Bridge Clinic
    • Child Welfare Programs
    • EARLY CARE And EDUCATION
    • family resource Centers
    • Telehealth
    • Forms
    • Billing and Insurance
    • Pay Your Bill
    • Patient Portal
  • About
    • Mission & History
    • Leadership
    • Advocacy
    • 2022-2024 Strategic Plan
    • 2021 Annual Report
    • 2019 Impact Report
    • 2020 – 2021 Audit
    • Our Corporate Partners
    • Our Affiliations
    • Auxilaries
      • Auxiliary Dues
      • Join an Auxiliary
    • Covid Updates
  • Contact
    • Press Inquiries
  • Careers
  • Events
  • Donate
    • Legacy Giving
    • Corporate Partner Opportunities
    • 2022 a la carte Event Sponsorships

Forms – School Based


Registration form
Asthma Control Test – ages 4-11
Asthma Control Test – ages 12+
Bright Futures Physical – age 3
Bright Futures Physical – age 4
Bright Futures Physical – age 5
Bright Futures Physical – age 6
Bright Futures Physical – ages 7-8
Bright Futures Physical – ages 9-10
Bright Futures Physical – ages 11-14
Bright Futures Physical – ages 15-17
Bright Futures Physical – age 18+
CBITS / Bounce Back Participation
Consent to Vaccination
Consent to FLU Vaccination
Consent to COVID-19 Vaccination
Health Assessment Record
PSC (Pediatric Symptom Checklist) Parent
School based mental health referral
Sports physical evaluation
Return to Forms

  • Facebook
  • Instagram

Stay Connected

Select list(s) to subscribe to


By submitting this form, you are consenting to receive marketing emails from: Child and Family Agency of Southeastern Connecticut, 255 Hempstead Street, New London, CT, 06320, http://www.childandfamilyagency.org. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact
  • Service
  • About
  • Careers
  • Covid Updates
  • events
  • Contact
  • Donate
© Pena Theme by Anariel Design. All rights reserved