REQUIRED MENTAL HEALTH FORMS: Printable
MH Required Forms
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)
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.
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.
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.
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.
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.
