Helpful Patient Resources

Patient Portal

View your records and pay your bill online

 

Go to the Patient Portal

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