Forms

FormsameliaLOPpage8SNfLK2025-04-17T23:37:40+00:00

Records Request Form

Record Request Form-1

Release of Information

New Patient Enrollment Form

Enrollment Form

Individual Rights and Responsibilities

Individual Rights 2021

Acknowledgment of Intake Documents

Acknowledgment of Intake Docs

Consent to Treat

Consent to Treat

Notice of Privacy Practices

Privacy Practices Notice

Declaration for Mental Health Treatment Guide & Instructions

Declaration for Mental Health Treatment (OHA 2012)

Declaration for Mental Health Treatment Form

Declaration MH Receipt

Grievance Procedure and Form

Grievance Procedure and Form