Valley Cities Forms

Intake Forms

The Intake Specialist will review these forms with you at your appointment:

1: Financial Agreement

2: Advance Beneficiary Notice

3. Fee Schedule

4. Receipt of Documents

5. Telehealth Consent Form

6. Electronic Communication Consent Form

7. Clinician Disclosure Statement

Download Intake Packet

(All documents)

Additional Forms

These forms are provided to you for your information and to inform you of your rights. Please review them before your intake appointment and let the Intake Specialist know if you have any questions.

1. Client Handbook

English

1.1 Manual del Cliente

(Español)

2. What You Can Expect From Your Counselor

Deparment of Health Document

3. Notice of Privacy Practices

Valley Cities

4. Notice of Privacy Practices

King County

5. Your Rights as a Behavioral Health Client

English

5.1 Sus Derechos como Cliente de Salud Conductual

Español

6. Mental Health Advance Directives Brochure

7. Mental Health Program Brochure

Valley Cities

8. Youth Services Roadmap

9. Preparing for Psychiatric Evaluation

Download Supplemental Documents Packet

(All documents)

School Based Forms

PLEASE PRINT, FILL OUT, AND RETURN COMPLETED FORMS TO YOUR CLINICIAN OR SCHOOL COUNSELOR.

1. Consent to Treatment

2. Feedback & Client Complains Procedure

3. Notice of Privacy Practices

Valley Cities

3.1 Notice of Privacy Practices

Español

4. Parent Permission Form

English

5. Financial Agreement

English

5.1 Financial Agreement

Español

6. Release of Information

English

6.1 Lanzado de Información

Español

Additional Forms for Youth With Medicaid

1. Client Handbook

English

1.1 Manual del Cliente

(Español)

2. What You Can Expect From Your Counselor

Deparment of Health Document

3. Notice of Privacy Practices

Valley Cities

4. Notice of Privacy Practices

King County

5. Your Rights as a Behavioral Health Client

English

5.1 Sus Derechos como Cliente de Salud Conductual

Español

6. Mental Health Advance Directives Brochure

7. Mental Health Program Brochure

Valley Cities

8. Youth Services Roadmap

Recovery Place Seattle Screening Form

RPS Screening Form

English

If you do not have access to a printer, please reach out to your school counselor or clinician who can assist in providing you printed copies of the forms or stop by one of our locations and ask for assistance.

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