Below are links to the preliminary intake forms to fill out and print. Once you have completed each form you can print and bring them with you saving time during the formal intake appointment.
NOTE: Some forms are only informational, you can print or download those for your records or simply refer back to them here.
Client Guide
Local Treatment and Support Resources
Mental Health Intake Forms
- Intake Data Form
- Client Agreement for Service
- Consent to Treat
- Client Rights and Responsibilities
- Notice of Privacy Practices
- Authorization for Release of Information
- Confidentiality Form
- Tele-Mental Health Release
- Consent to Communicate
- Consent to Use and Disclose Health Information
- Family Involvement Agreement
- Physical Exam Referral
Substance Use Intake Forms
- Intake Data Form
- Health Insurance Claim Form
- Client Agreement for Service
- Consent to Treat
- Consent to Communicate
- Consent to Use and Disclose Health Information
- Tele-Mental Health Release
- Notice of Privacy Practices
- Confidentiality Form
- Client Rights and Responsibilities
- Agreement for Urine Monitoring
- Urine Monitoring Release Form
- Alternate Provider Options Notice
- Family Involvement Agreement
- Release of Information – SA
- Authorization for Release of Information – SA
- HIV – TB Testing Consent
- Physical Exam Referral
- ACE Questionnaire
- BECK Depression Inventory
- Michigan Alcoholism Screening Test
- Spiritual Assessment
