Intake and Referral Forms
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Please Make Sure to Download All Applicable Forms in This Category
| A0001 | Adult Information Form | Complete / Return | 1 pages |
| A0001CL | Adult History Form | Complete/Return | 4 pages |
| A0002 | Form-Insurance ROI - Oregon Only | Complete / Sign | 1 pages |
| A0002W | Form-Insurance ROI - Washington Only | Complete / Sign | 1 pages |
| A0003 | Policy Statement: General | Read / Sign | 2 pages |
| A0004 | Informed Consent for Treatment or Evaluation | Read / Sign | 3 pages |
| A0005 | Notice of Privacy Practices | Review | 5 pages |
| A0006 | Notice and Acknowledgement: HIPAA | Read / Sign | 1 pages |
| A0010 | Adult Questionnaire | Complete/Return | 1 pages |
| A0010sp | Adult Questionnaire/spanish | Complete/return | 1 pages |
| CUP01 | CUP Policy Statement (WA Only) | Complete / Return | 2 pages |