Patient Forms

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Release of Information

Electronic Releases

Mental Health Release of Information
Substance Use Disorder Release of Information

Printable Releases

Mental Health Release of Information
Substance Use Disorder Release of Information

Outpatient Psychiatric Medication Management

Adult Psychiatry Medication Management - NEW PATIENT FORMS
Child Psychiatry Medication Management - NEW PATIENT FORMS
Tele-Psychiatry Consent Form
Adult Psychiatry Intake Packet – PDF file
Child/Adolescent Psychiatry Intake Packet – PDF file

Psychological Evaluation

Mental Health Evaluation/Testing Consent and Information Form
ADD/ADHD Non-Covered Testing Agreement (BCBS)
Adult Psychological Testing Intake Form
Child Psychological Testing Intake Form

Adult Rehabilitative Mental Health Services (ARMHS)

Rights and Responsibilities
Community-Based (ARMHS & CTSS) Notice of Privacy Practices

Behavioral Health Home (BHH)

DHS-BHH Team Consent Rights & Responsibilities
BHH Rights & Responsibilities
Crisis Management Plan

Children's Therapeutic Services and Supports (CTSS)

Rights and Responsibilities
Community Based Fee and Policies Agreement
CTSS Treatment Plan Signature Form
CTSS FINANCIAL RELEASE and PRIVACY RIGHTS NOTIFICATION
Community-Based (ARMHS & CTSS) Notice of Privacy Practices

Adult Day Treatment (ADT)

ADT Intake Packet

Nutrition Counseling Services

Intake Packet 18+
Intake Packet 13-17
Intake Packet 12 & Under
Adult Health Screening Questionnaire (18+)
Adolescent Health Screening Questionnaire (13-17)
Child Health Screening Questionnaire (12 & Under)

General Forms

Patient Rights Handout
Notice of Privacy Practices
Fee Agreement
Notice of Nondiscrimination

Substance Use Disorder Forms

SUD Orientation ADDITIONAL Online Forms
Client Privacy Rights - Tennessen Notice
Notice of Appeal Rights
SUD Intake and Orientation Form Page 1
SUD Intake and Orientation Form Page 2
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