Print and sign this form to allow visits via video and/or phone

The Health Insurance Portability and Accountability Act of 1996 Compliance Information

Release of Information Form – (Form that allows us to communicate with facilities or individuals about your treatment)

Fillable referral form for individuals seeking services. Can also be found in the New Client- Contact tab or in the For Collaborating Professionals tab.

Confidentiality of clients within facility with substance use disorders.