Intake forms provide important information to your provider. Please click on the appropriate form for your specific intake. Each intake requires the demographic & consent form, the intake form, and the assessment based on age to be filled out and submitted. The online forms will open in Adobe Sign for you to fill out, sign, and submit electronically to our administrative department. After filling out, signing, and pressing SUBMIT, you will receive a copy of the paperwork.
Paperwork must be submitted 24 hours prior to your scheduled intake appointment. If the paperwork for medication management intake appointments is not submitted 24 hours prior to your scheduled appointment, your appointment will be cancelled and you will need to reschedule. If you are having issues with opening the forms, please contact us.
Adult Individual Therapy
Child/Adolescent Individual Therapy
Note* - Parents/guardians need to sign the consent form.
Note* - If there is a JOINT CUSTODY situation, both parents need to sign the consent form. Please go to the Child Consent Form for additional parent signatures:
Note* - Both partners need to fill out the three (3) online forms or the Adult Therapy Packet.
Adult Medication Management
Child/Adolescent Medication Management
Note* - Only one assessment link is required based on the age of the child client.
- ROI (Release of Information) Form - Therapy
- ROI (Release of Information Form) - Medication Management
- Adult Controlled Substance Agreement
- Child/Adolescent Controlled Substance Agreement
- Notice of Privacy Practices
- River Valley Pet Policy
- Psychological Testing Billing Agreement
- Psychological Evaluation with Testing Form
- Credit Card Payment and Authorization Form
Note* - It is RVBHWC policy to have all records requests in writing by filling out a Release of Information (ROI), even if the request is the client for their own record.
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