24-Hour Crisis Hotline
866.275.9552
Suicide Prevention Lifeline
800.273.8255

Client Rights Handbook

English:Cardinal | English:Sandhills | English:VAYA/Partners | Spanish

Client Rights Annual Update Form

English | Spanish

Client Rights Annual Handout

English


Patient Information Form

English | Spanish


New Client Service Orientation

English


Authorization for Treatment

English | Spanish

FBC/Day Treatment - Authorization for Treatment

English

MH/SA Treatment Agreement (OP Treatment Agreement)

English | Spanish


Financial Agreement

English | Spanish

Service Fee & Sliding Scale

English | Spanish

Notice of Privacy Practices

English | Spanish

No Income Verification

English | Spanish

Cash Only Verification

English | Spanish

Financial Intake Letter

English


ROI-MCO/CCNC/My Health Insurance

English | Spanish

ROI-NCTOPPS/GPRA

English | Spanish

ROI/Primary Care Provider

English | Spanish

ROI - Emergency Contact

English | Spanish

ROI - U.S. Federal Probation/Probation Officer

English

ROI - County Probation

English

ROI - Legal Guardian

English: Parent/Guardian | English: Foster Parents | English: Guardian Ad Litem

Spanish: Parent/Guardian | Spanish: Foster Parents

ROI - Schools

English | Spanish

ROI - Department of Social Services

English | Spanish

ROI - Dominion Diagnostics

English | Spanish

ROI - Highline Labs

English | Spanish

ROI - Medicaid Transportation

English | Spanish

ROI - Nursing Home / Assisted Living / Group Home

English | Spanish

ROI - Family Friends

English

ROI Attorney

English

ROI - Blank Form

English