Antolino Family Wellness Center - Schedule Intake Assessment
Antolino Family Wellness Center - Dedicated to Family and Community Wellness
Schedule Intake Assessment
 
This page is to schedule an appointment only, this is NOT an intake assessment. This page will allow you to schedule an appointment to partake in an intake assessment, which is required to enroll in one of our programs. Please fill out the form below and one of our staff members will contact you via email to confirm your appointment. Should you have any questions, please feel free to contact our office at (650) 898-8134.
 
There is a registration fee for all intake assessments. You must bring in cash, money order, or cashier's check (no checks) the day of your appointment. A registration fee must be paid in order to register, should you fail to pay the registration fee, you will not be able to register for the program. We will contact you via email with the registration fee amount.
 
The following is required and must be brought the day of your appointment, in order to register with the program:
 
1. Registration Fee (we will contact you via email with the registration fee amount)
2. Gold Referral Form (SF County only)
3. Copy of Court papers (green or yellow form)
3. Proof of Income i.e. pay stubs, W-2's, tax returns, bank returns, EDD papers, disability etc.
4. Copy of your photo ID
 
Should you fail to bring these items, you will not be allowed to register with the program.
 
Full Name
Address
City, State, Zip Code
Email Address
Home Phone Number
Cell Phone Number
What county is your case in, if any? For example: San Francisco County, San Mateo County, Santa Clara County. Please note, it may not be the county you live in, it's where you attend court.
Court Case#, if any
Probation Officer Name, if any
Probation Officer Phone Number, if any
Pick Location and Time of Appointment for Intake Assessment
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