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Affiliate Forms

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To remain an official CDAPP Sweet Success Affiliate, the following forms must be filled out and returned to the CDAPP Sweet Success Resource and Training Center annually.  Please use the online submission form to send your information.  If you choose the Word Document version of either form you may print and fax (844-653-6198) the Word Document or email it to cdapp@perinatalnetwork.org.  Feel free to call 714-921-9755 if you have any questions. 

Two Forms Due: Wednesday, January 31, 2018
These forms will be available mid-December!

Form 1: 2018 Memorandum of Understanding (MOU)

Form 2:
Annual Affiliate Survey with your 2017 Client Data
Before filling out survey have these items ready:
      1. A list of all your affiliate sites, addresses, and contact information
      2. Staff education information (e.g. webinars attended, license numbers, emails for all staff seeing patients)
      3. Aggregate Client Data for all your sites


Other Forms

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If you would like to apply to become a CDAPP Sweet Success Affiliate, please fill out and submit the following:
CDAPP Sweet Success New Affiliate Application Form

If you wish to collect your own data on your patients, here is a sample data collection form for your use.
CDAPP Sweet Success Individual Affiliate Data Form (Word)

If you would like a quick summary of the types of client categories, services usually rendered, and CPT codes most often used when billing for these services, see the document below.  (This document is intended for use with non-CPSP payers.)
Example: Client, Length of Visit, Service, CPT Code