Helpful Patient Resources
Forms
- Intake
- Psych only intake
- SBHC registration
- Statement of custody, application for service and service agreement
- Client rights and responsibilities
- Notice of Privacy Practices
- Release of information and assignment of benefits
- Financial responsibility agreement for counseling services
- Consent and notice regarding electronic signatures
- Consent to telehealth
- Ohio Youth
- Ohio Parent
Surveys
- YSSF (youth satisfaction survey form?)
- Intensive Family Preservation (IFP) Client Satisfaction Survey
- RTFT Client Satisfaction Survey
- IPV Client Satisfaction Survey