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.
  1. Materials about DOJ Recognition and Accreditation, including a Step by Step guide that contains templates and other sample materials and saved webinars on the process are located here.
  2. Case management materials, including sample policies and procedures manuals and sample forms such as client retainers and intake forms are located here.
  3. Our training calendar is located here.
  4. Information about our upcoming annual Convening, located in Phoenix, AZ this year, is located here.
  5. Information about CLINIC benefits and how to become a CLINIC affiliate can be found here.
Please note that all CLINIC offices will be closed on Monday, May 29 in observance of Memorial Day. The Information Request Form will close on Saturday, May 27 and re-open on Tuesday, May 30.

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