Patient Forms

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Release of Information

Electronic Releases

Mental Health Authorization
Substance Use Disorder Authorization
Primary Care Provider Authorization
Psychiatry Primary Care Provider Authorization

Printable Releases

Mental Health Authorization
Substance Use Disorder Authorization
Primary Care Provider Authorization
Psychiatry Primary Care Provider Authorization

Outpatient Psychiatric Medication Management

Adult Psychiatry Medication Management - NEW PATIENT FORMS
Child Psychiatry Medication Management - NEW PATIENT FORMS
Primary Care Provider to Release Information for Psychiatry
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)
Child/Adolescent Testing Intake Packet
Adult Testing Intake Packet

Adult Rehabilitative Mental Health Services (ARMHS)

Rights and Responsibilities

Children's Therapeutic Services and Supports (CTSS)

Rights and Responsibilities
Child and Adolescent Assessment for Caregiver

Adult Day Treatment (ADT)

Client Contact Information
Medication List
PHQ9

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
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