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Complete Intake Packet Downloads

Private Insurance ADULT 4.3.25 (pdf)Download
Private Insurance CHILD 4.3.25 (pdf)Download
Soonercare ADULT 4.3.25 (pdf)Download
Soonercare CHILD 4.3.25 (pdf)Download
VA 4.3.25 (pdf)Download
Private Pay ADULT 4.3.25 (pdf)Download
Private Pay CHILD 4.3.25 (pdf)Download
SPANISH Private Pay ADULT 4.3.25 (pdf)Download
SPANISH Private Pay CHILD 4.3.25 (pdf)Download
SPANISH Soonercare ADULT 4.3.25 (pdf)Download
SPANISH Soonercare CHILD 4.3.25 (pdf)Download

Misc Paperwork Downloads

Child Signature Page 3.14.25 (doc)Download
Adult Signature Page packet 3.14.25 (pdf)Download
Discharge Summary 01.2020 (doc)Download
Adverse Incident Report ORIGINAL (doc)Download
ROI (doc)Download
Court Report Template 03.2021 (doc)Download
Safety Agreement (docx)Download
VA ROI (pdf)Download
Referral Form 01.15.2024 (docx)Download
BioPsych Adult 12.23.2023 (docx)Download
BioPsych Child 12.23.2023 (docx)Download
BioPsych Adult 12.27.2023 fillable (docx)Download
BioPsych Child 12.27.2023 fillable (docx)Download
OP Staffing and Assignment (pdf)Download

Misc Paperwork Downloads

Fee Schedule - Cash Pay 01.2025 (docx)Download
Fee Schedule - Private Insurance 01.2025 (docx)Download
Fee Schedule - Medicaid 08.2024 (docx)Download
Addendum to Services - CM 12.29.2023 (docx)Download
Addendum to Services - ADHD Testing (docx)Download
Addendum to Services - Blank 12.29.2023 (docx)Download
DHS APS Critical Incident Report Form 01.2020 (pdf)Download
Transition Plan (doc)Download
PHQ9 (docx)Download
Client Orientation 01.05.2025 (docx)Download

Misc Paperwork EXAMPLES

SAMPLE Discharge Summary CX not present (pdf)Download
SAMPLE Transition Plan CX not present (pdf)Download
SAMPLE Discharge Summary CX Present (pdf)Download
SAMPLE Transition Plan CX Present (pdf)Download
SAMPLE Addendums (pdf)Download
SAMPLE BioPsych (pdf)Download
SAMPLE Consents, Screeners, Signature Page Packet (pdf)Download
SAMPLE Critical and Adverse Incident Reports (pdf)Download

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