To download and print the below forms, click the form and then click "Open." Print out the forms, complete, and bring with you to your appointment. If you have any problems accessing these forms, please contact us at info@lanternlanefarm.org or at (615) 973-5454.

New Client Forms: Adult

Adult New Client Form
Please print these forms. Complete, sign, and bring with you to your appointment.
LLF_Adult Intake Form_122015.pdf
Adobe Acrobat document [284.2 KB]
Release of Liability
Please print this form, complete, sign, and bring with you to your appointment.
Release of Liability Agreement 6-2013.pd[...]
Adobe Acrobat document [103.0 KB]

New Client Forms: Child

Child/Minor New Client Form
Please print these forms. Complete, sign, and bring with you to your first appointment.
LLF_Child-Adolescent Intake Form_01_2016[...]
Adobe Acrobat document [291.8 KB]
Release of Liability
Please print, complete, and return this form with your new patient forms.
Release of Liability Agreement 6-2013.pd[...]
Adobe Acrobat document [103.0 KB]

New Client Forms: Child Occupational Therapy

New Client: Occupational Therapy Form
Please print these forms. Complete, sign, and bring with you to your first appointment.
New Client OT Form.pdf
Adobe Acrobat document [313.2 KB]

Release of Consent Form

Adult Release of Consent Form
Complete and submit this form in order to allow Lantern Lane Farm to share your information with third parties (ex: primary doctor, insurance, legal counsel, etc).
Adult Release of Confidential Informatio[...]
Adobe Acrobat document [323.8 KB]
Minor Child Release of Consent Form
Complete and submit this form in order to allow Lantern Lane Farm to share your minor child's information with third parties (ex: primary doctor, insurance, legal counsel, etc).
Minor Release of Confidential Informatio[...]
Adobe Acrobat document [327.7 KB]

Donation Form

General Donation Form
Please print this form. Complete and mail or drop off to our center at 6201 Corinth Road, Mt Juliet, TN 37122
LLF_Donations.pdf
Adobe Acrobat document [96.0 KB]

Adopt an Animal Application

Adopt an Animal Form
Please print this form. Complete and mail to our center at 6201 Corinth Road, Mt Juliet, TN 37122
AdoptanAnimal.pdf
Adobe Acrobat document [328.9 KB]

Contact Us:

Telephone:

(615) 973-5454

 

Fax:

(615) 220-0051

 

Log Cabin (Main Counseling Offices):

1901 Logue Road Mount Juliet, TN 37122

 

Farm Location:

6201 Corinth Road Mount Juliet, TN 37122

 

 

info@lanternlanefarm.org



Client Forms

New client? Save time and reduce the amount of paperwork at your first visit. We provide several client forms as downloads on our site.

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