Pathways Mental Health Services

mental health forms

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REQUIRED MENTAL HEALTH FORMS: Printable
MH Required Forms
  1. Demographic Form
  2. Informed Consent
  3. Privacy Act & HIPAA
optional forms
1. Release of Information Form - Optional; Complete if you would like us to communicate with anyone about your care. Required to communicate with parents of adolescents 13 years and older.
2. 
Audio/Video Consent Form - Play Therapy only (Required for 6 to 12 year old)
​3. Notice of Privacy Act - Read Only (For your records; do not return to Pathways)


We cannot process your intake paperwork until we received all of the required forms and a copy of your insurance card and picture ID. 
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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. Please do not email insurance cards or other confidential information as email is not a secure method of transmission. Once we have all forms and have verified your insurance coverage, we will call you to schedule an initial assessment.  
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Notice: Due to Washington health care laws, ​the ROI form should be completed by clients age 13 and up if a parent or other party will need to communicate with us about scheduling or other information.
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​Email:  info@pathwaysmhs.org 
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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