CLIENT FORMS

Consent Forms

This consent packet includes the Agreement to Treatment, Client Rights, Rules and Regulations, HIPAA Notice and Consent, Telehealth Consent, and Patient Financial Responsibility Agreement. These forms explain your rights and responsibilities, how your health information is protected, expectations for receiving services, and your financial obligations.

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Carelon Attestation Discharge Form

Attestation to Discharge Conflicting/Overlapping Authorization(s) Due to Non-Overlap Requirement

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HIPAA Release of Information

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Your privacy matters to us. To allow us to share your health information with another person or organization, please complete a Release of Information form. You control who we share with, what is shared, and for how long. You may revoke consent at any time.

Grievance/Complaint Form

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At You First Health Systems, we value your feedback. If you ever have a concern about your care or services, you have the right to file a grievance or complaint without fear of retaliation. All concerns will be reviewed promptly and handled with fairness and confidentiality.

CLIENT FORMS

Consent Forms ​​

Carelon Attestation Discharge Form ​​

HIPAA Release of Information ​​

Grievance/Complaint Form​

Consent Forms

Carelon Attestation Discharge Form

HIPAA Release of Information

Grievance/Complaint Form