Patient Forms

Access and complete your intake forms and patient documents securely online.

Secure HIPAA-Compliant Forms

Complete Your Forms Online

Nurse with stethoscope completing patient paperwork

Required Treatment Agreement

Modified Intake Packet

Medical history questionnaire with stethoscope on clipboard

Outpatient Services Intake Packet

Complete this form to begin the intake process for outpatient services.

Clipboard with pen and scattered medications

Controlled Substance Agreement

Suboxone/Buprenorphine Patient Form

Signing construction document with yellow hard hat

Consent to Release and Exchange Information

Permission to Communicate with Others Regarding Your Care

Smiling female doctor consulting senior male patient

DWI Intake Packet

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

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Residential Recovery Supports Intake Packet

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

Download Intake Form

SHYAS 2023 Intake (pdf)

Required Treatment Agreement (pdf)

Controlled Substance Agreement (pdf)

Consent to Release and Exchange Info (pdf)

New Patient Questionnaire (pdf)

Patient Follow Up Form (pdf)