Medical Form

Thank you for your interest in the Teen Challenge program. Please print the medical form below and give to your doctor.

ripple in water
Medical Form for applicant
Medical Form for applicant's children

Contact us

888-339-3193
info@teenchallenge.net

390 MATHEW STREET
SANTA CLARA, CA 95050
UNITED STATES

other helpful numbers

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Suicide Prevention Lifeline:
1-800-273-8255 | TTY: 1-800-799-4889

SAMHSA's National Helpline:
1-800-662-4357 | TTY: 1-800-487-4889

Disaster Distress Helpline:
1-800-985-5990 

Veteran's Crisis Line:
1-800-273-8255 | TTY: 1-800-799-4889

Domestic Violence Hotline:
1-800-799-7233 | TTY: 1-800-787-3224