Pathways Mental Health Services

cd forms
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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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  • Home
    • Staff
    • Providers
    • Satisfaction Survey
  • Clinics
    • Lacey Clinic
    • Longview Clinic
    • Telehealth Clinic
    • Telehealth International
  • Mental Health Counseling Services
    • Co-occurring Disorders Treatment >
      • Co-occurring Disorders Group
    • Mental Health >
      • Outpatient Services
      • Group Therapy
      • Play Therapy
    • Trauma Focused Treatment
  • Addiction Services
    • DOT - SAP Services
    • Outpatient Services
    • Relapse Prevention Therapy
    • Gambling Services
  • Insurance
    • Accepted Insurance
    • Accepted EAP
  • Online Testing & Screening
  • Training
  • Patient Portal
  • Therapy Interest Form
  • School Services