Pathways Mental Health Services
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cd forms
not fillable online

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
Client's Rights
Consent to treatment
Grievance Sheet
Patient Notice - HIPAA compliance
HIV Brief Risk Intervention
TB Risk Screen

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COMPANY:
About Us
Employment

Pathways Staff
Pathways Providers
SUPPORT:
​Email: ​ PMHS Admin
​
Text:   360-777- 7284
​Phone:  360-799-5782
NEW PATIENT:
Insurance
Hours of operation
​
Reinstatement Form
​
Release of Information Form
​Informed Consent & HIPAA

Therapy Interest Form ​
OUR SERVICES:
DOT-SAP
LGBTQI Services

Mental Health

Trauma Treatment/EMDR
Intake & Wellness Program


TELEHEALTH:
​​Telehealth
Crisis Resources
TRAINING:
Mental Health First Response
OTHER:
Clinical Supervision
​
Internship Program
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  • Home
    • Staff
    • Providers
    • Satisfaction Survey
  • Olympia Clinic
  • Mental Health Counseling Services
    • Mental Health >
      • Outpatient Services
      • Group Therapy
    • Trauma Focused Treatment
    • DOT - SAP Services
  • Therapy Interest Form
  • Online Testing & Screening
  • Patient Portal