Forms

Forms for Families

Please print and complete the following forms and fax or mail to:

Fax: 978-834-6760
Lucy's Love Bus, PO Box 464, Amesbury, MA 01913

• Application
• Medical history
• HIPAA Form
• Authorization to release medical information
• Request for Continuation of Services
• Release
• Medical Permission Form

* PLEASE NOTE: Do not fill out the Request for Continuation of Services if this is the first time you are applying to Lucy's Love Bus. 

Forms for Practitioners

Fax or mail paperwork to:

Fax: 978-834-6760
Lucy's Love Bus, PO Box 464, Amesbury, MA 01913

• Application for Partnering Practioners
• Checklist and Protocol for Partnering Practitioners
• Survey for Children

Form for Lucy's Love Corp

• Lucy's Love Corp Registration Form