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 on Thursday, June 19th in observance of Juneteenth. The Information Request Form will close on Wednesday, June 18th at 5 p.m. ET and reopen on Friday, June 20th.
 

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

User info