24-Hour Crisis Line: (503) 325-5724

Clients may choose to complete and submit paperwork online. To do so, click on the link(s) below. 

For more information, please call 503-325-5722.

Mental Health Services

Adult Mental Health Enrollment Packet (English)

Youth Mental Health Enrollment Packet ~Ages 0-13~

(Spanish)
(English)

Youth Mental Health Enrollment Packet ~Ages 14+~

(Spanish) (English)

Outpatient Mental Health Enrollment Packet (Spanish)

North Coast Pain Clinic Enrollment Packet (English)

Alcohol & Drug Services

Alcohol & Drug Enrollment Packet ~ Ages 14+ ~

(English) Alcohol & Drug Enrollment Packet 
~ Parental/Guardian Consent ~ (English)

Mandated Treatment Services

Mandated Treatment Enrollment Packet 
~ Ages 14+ ~ (English) Mandated Treatment Enrollment Packet 
~ Parental/Guardian Consent ~ (English)

Referral Forms

CBH Outpatient Referral Form (English)

Medication Assisted Treatment (MAT) Referral (English) Psychiatric Consult Only Referral (English) Residential Referral
North Coast Crisis Respite Center (English) Respite Referral 
North Coast Crisis Respite Center (English)

Release of Information

Release of Information Form (English) Primary Care Provider Release of Information (English)

Financial Forms

(Spanish)

Fee Schedule 

(English)

Sliding Scale Discount Application

(English) (Spanish)

Information & Notices

Complaint and Resolution Form

(English)

Declaration of Mental Health Treatment

(English) (Spanish)

Notice of Privacy Practices

(English) (Spanish)

Orientation Packet

(Spanish) (English)

Voter Registration

(English) (Spanish)