Required Chemical Dependency Forms:
We cannot process your intake paperwork until we received all of the required forms and a copy of your insurance card and picture ID.
Please fax all the required forms and a copy of your photo ID and insurance card to (360) 539-1715 in Lacey or to (360) 846-1722 in Longview. Once we have all forms and have verified your insurance coverage, we will call you to schedule an initial assessment.
Demographic Form - Required for all adult patients
Demographic Form - Required for all adolescents patients (13 to 17 year old)
Program Rules & Polices / Informed Consent - Required for all adolescents patients (13 to 17 year old)
Release of Information - Optional; Complete if you would like us to communicate with anyone about your care.
Additional CD Forms: To be completed with your counselor
Counselor Disclosure to Client
Consent to treatment
Patient Notice - HIPAA compliance
HIV Brief Risk Intervention
TB Risk Screen