Parent-Provider Agreement FormParent-Provider Agreement • September 30th, 2019
Contract Type FiledSeptember 30th, 2019Step 2: Make sure all sections have been filled in and the information is correct. Answer all Yes or No questions by checking the right box. Once you have filled out and checked this form, make sure the parent and provider sign and date this form. If you need help, call 1-888-214-5437 or visit www.ctcare4kids.com. Incomplete forms may not be accepted and will delay processing.