Intake and Referral Forms
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Please Make Sure to Download All Applicable Forms in This Category
| C0001 | Child / Adolescent Information Form | Complete / Return | 1 pages |
| C0001CL | Child/Adolescent History Form | Complete/Return | 5 pages |
| C0002 | Form-Insurance ROI - Oregon Only | Complete / Sign | 1 pages |
| C0002W | Form-Insurance ROI - Washington Only | Complete / Sign | 1 pages |
| C0003 | Policy Statement: General | Read / Sign | 2 pages |
| C0004 | Informed Consent for Treatment or Evaluation | Read / Sign | 3 pages |
| C0005 | Notice of Privacy Practices | Review | 5 pages |
| C0006 | Notice and Acknowledgement: HIPAA | Read / Sign | 1 pages |
| C0007 | Minor to Consent to Treatment | Read / Sign | 1 pages |
| C0010 | Child Questionnaire | Complete/Return | 1 pages |
| C0010cg | Child Questionnaire/Caregiver | Complete/Return | 1 pages |
| CUP01 | CUP Policy Statement (WA Only) | Complete / Return | 2 pages |
| OHP0003 | OHP Rights and Responsibilities | Read/Sign | 2 pages |
| Y0010 | Youth Questionnaire | Complete/Return | 1 pages |
| Y0010cg | Youth Questionnaire/Caregiver | Complete/Return | 1 pages |