Information Request Form

Thank you for your interest in CLINIC. Due to high volume, we are unable to respond directly to all received inquiries at this time. Already a CLINIC Affiliate? Visit the Affiliate Portal to take advantage of all your Affiliate benefits.

Below are several resources that Affiliates in the CLINIC network often find valuable.

DOJ Recognition and Accreditation

CLINIC Affiliation

Case Management Materials 

Sample policies and procedures manuals and sample forms such as client retainers and intake forms are located here.

Upcoming Trainings

Visit out Training Calendar to learn more about upcoming trainings.
 

CLINIC's offices will be closed in observance of Memorial Day on Monday, May 26,2025, followed by Convening. The Information Request Form will close on Wednesday, May 21st at 5 pm ET and reopen on Monday, June 2nd.
 

Please provide us with the following information. A CLINIC staff member will contact you within three business days after submission.

User info