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Streamlined Patient Forms

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Treatment Consent

Medication Agreement

Treatment Consent

Modified Intake Packet

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Outpatient Intake

Medication Agreement

Treatment Consent

The complete Intake Packet complete packet 1 and packet 2

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Medication Agreement

Medication Agreement

Medication Agreement

Suboxone/Buprenorphine Patient Form

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DWI Treatment Forms

Recovery Support Forms

Medication Agreement

Permission to Communicate with Others Regarding Your Care

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Recovery Support Forms

Recovery Support Forms

Recovery Support Forms

Complete Intake Packet for ADETS, Short Term Treatment, Long Term Treatment, IOP or Residential Treatment

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Info Release Consent

Recovery Support Forms

Recovery Support Forms

Complete SHYAS CARES Intake Packet for  Residential Recovery Supports Program Phase 1 and Phase 2

Get Your Health Forms

SHYAS 2023 Intake (pdf)

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Required Treatment Agreement (pdf)

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Controlled Substance Agreement (pdf)

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Consent to Release and Exchange Info (pdf)

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New Patient Questionnaire (pdf)

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Patient Follow Up Form (pdf)

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  • Crisis Center
  • Outpatient Services
  • Intensive In Home
  • Medication Management
  • Suboxone
  • Substance Use Services
  • Peer Support
  • Community Support Team
  • SUD Residential Supports
  • Referrals
  • Patient Forms
  • Career Opportunities
  • Get Licensed
  • Employee Home Page
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