Please pick from the selections below the specific PandaDoc Document you wish to send.

Note: All forms Automatically go to Med Records after completion.  Any document with CANS authorization will also automatically go to Laurie Darr

Packets - English

Regular Intake

Intake with CANS/ICC

PHI Bundle - 10 Releases

PHI Bundle and PCP Communication Form - 10 Releases

PHI Bundle w/ CANS/ICC - 10 Releases

PHI Bundle w/ CANS/ICC and PCP Communication Form- 10 Releases

SUD Second packet

ACRA Intake packet

WISE Intake packet

SOAR Intake packet

Packets - Spanish

Regular Intake

Intake with CANS/ICC

PHI Bundle - 10 Releases

PHI Bundle and PCP Communication Form- 10 Releases

PHI Bundle w/ CANS/ICC - 10 Releases

PHI Bundle w/ CANS/ICC and PCP Communication Form- 10 Releases

WISE Intake Packet

Individual Forms - English

PHI Release (ROI) - Individual

Insurance Card Collection

Attendance Contract

CANS Authorization Form

ICC Evaluation Form

Consent to Treat

Emergency Contacts

Telehealth Agreement

Transportation Waiver

Treatment Plan Acknowledgement

BCBS Services Consent Letter

Permission to Record - Interns

Individual Forms - Spanish

PHI Release (ROI) - Individual

Insurance Card Collection

Attendance Contract

CANS Authorization Form

ICC Evaluation Form

Consent to Treat

Emergency Contacts

Telehealth Agreement

Transportation Waiver

TEST ENVELOPES

Test Intake - DO NOT USE FOR ACTUAL CLIENTS

Test Releases - DO NOT USE FOR ACTUAL CLIENTS

CBHI Documents

Acknowledgement of Payments English

Acknowledgement of Payments Spanish

Psych Testing Documents

Psychological Assessment Intake