Client Forms

Have you completed a request for services with our Access Department? If so, please complete your pre-assessment paperwork below. If not, please contact our Access Department at 425-349-8200 / 844-822-7609 or complete our Online Referral Form to start your referral process.

Instructions on how to sign & submit the below Pre-Assessment forms electronically

Forms should be completed using Adobe Acrobat Reader DC on your computer or mobile device. Adobe Acrobat Reader DC is free to download here.

Pre-Assessment Forms

After speaking with the Access Team, if you will be participating in a Telehealth appointment, fill out the Pre-Assessment Forms. You can access each form below by clicking on the name of the form in orange. If you need help downloading and completing the forms on your computer or smart phone, please refer to the above instructions on how to sign & submit the pre-assessment forms electronically.

  • Consent for Treatment
    • The following individuals may sign a Consent for Treatment:
      • Adults age 18 and older, unless declared incapacitated by a court of law (i.e. have a legally appointed guardian).
      • Minors age 13-17
      • Parents of a minor child (age 17 or younger) – adolescents should sign their own pre-assessment paperwork forms
      • Legal guardians
      • Kinship Caregivers – family members of a child under the age of 13 who are providing care for the child in the absence of a parent or legal guardian. Parent/guardian is not available.
      • If the client is unable to sign for themselves (i.e. under 13, or an adult with a legal guardian) someone who can sign consent must attend the assessment with the client, or must sign the Consent for Treatment in advance).
    • How to complete the Consent for Treatment:
      • Check all applicable boxes on pages 1
      • Sign and date on page 4
      • Enter your Name & DOB on each page
      • Only Kinship Caregivers must complete page 5
  • ROI (Release of Information) see note below
    • If you are not intending to release, exchange, or disclose your medical records to another individual, then do not complete the ROI at this time.
    • Who can sign an ROI? If the client is 13 or above, they must sign the ROI; if the client is 12 or younger, a parent/guardian must sign the ROI.
    • In order to best assist your treatment, it is strongly encouraged to complete the following ROIs:
      • PCP
      • If a minor client is age 13 or above, we strongly encourage an ROI for the parent or guardian.
      • Other typical ROIs that we request from new clients include requests from School Counselors, Social Workers, other Medical Providers including recent hospitalizations, etc.
    • Instructions for completing an ROI:

If this is a standalone request for information unrelated to submitting pre-assessment forms, please go to our Health Integration Management page.

  • Client Forms Submission

Client Forms Submission

Please submit your completed forms here (Consent for Treatment and ROI). Please submit all the signed and dated forms together.

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