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Clayton’s House Guest Application
Clayton’s House Guest Application and Waiver Form For completion by Guest Submission of this completed Form is a pre-requisite to a Guest’s stay at Clayton’s House. Identification of Guest Name:(Required)...Space to Breathe Media Release 2024 – Adult
...S2B participants, specifically photos and videos captured of me during my participation in this year’s S2B program. By completing this form, I understand and acknowledge that this constitutes permission for...Clayton’s House Care Partner Application
Clayton’s House Care Partner Application and Waiver Form For completion by Care Partner Submission of this completed Form is a pre-requisite to a Guest’s and Care Partner’s stay at Clayton’s...Clayton’s House Referral Form
Clayton’s House Referral Form for Application for Stay For completion by a clinical team member from the patients treating HealthCare Provider The Dempsey Center offers programming in Lewiston & South...Space to Breathe Media Release 2024
...S2B participants, specifically photos and videos captured of me during my participation in this year’s S2B program. By completing this form, I understand and acknowledge that this constitutes permission for...Client Registration Form – Virtual Client
Thank you for telling us about yourself. This information is used to help the Dempsey Center develop and schedule services for you. Please note, you must complete registration paperwork (including...Medical History Form
...to give my physician information regarding the outcome(s) of this and any future sessions. I understand that Dempsey Center complementary therapy practitioners may review my session records but all my...Comfort Care Items
...comfort and ease your journey with cancer All our comfort care items are handmade with care by Dempsey Center volunteers for Dempsey Center clients. If you feel you would benefit...Complementary Therapies for Cancer Treatment are Coming of Age
Space to Breathe Kieve Wavus Waiver Adult
...services, equipment and premises (“Facilities”) and any participation in KWE programs and activities (“Programs”) comes with inherent risks including, but in no way limited to: (1) moderate and severe personal...Space to Breathe Kieve Wavus Waiver
...below (“Minor”) acknowledge and agree that any use of KWE facilities, services, equipment and premises (“Facilities”) and any participation in KWE programs and activities (“Programs”) comes with inherent risks including,...Contact Us
Do you have questions about our cancer services and resources? Contact The Dempsey Center team, and we will be happy to get you more information.Clayton’s House Host (Client Facing Position)
Serve as “host or hostess” while providing a calming, supportive, neighborly presence – offering compassionate companionship to guests and caregivers.Youth and Family Services
Healing Tree Youth and Family Services at The Dempsey Center offers children, youth, and their families cancer support services and youth and family counseling.Individual Oncology-Focused Counseling Intake Questionnaire
Individual Oncology-Focused Counseling Intake Questionnaire Please be aware that submitting this form does not guarantee counseling services. Upon receipt and review of your completed form, your name will be placed...Informed Consent – Youth + Family
...have the right to know about the confidential communications we have with your child. Confidential communications may be shared with you at your request, unless a licensed clinician determines, based...
