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

Individual Forms - English

PHI Release (ROI) - Individual

Insurance Card Collection

Attendance Contract

CANS Authorization Form

ICC Evaluation Form

Consent to Treat

Emergency Contacts

Individual Forms - Spanish

PHI Release (ROI) - Individual

Insurance Card Collection

Attendance Contract

CANS Authorization Form

ICC Evaluation Form

Consent to Treat

Emergency Contacts

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