Forms
Forms
Please click on the below forms to download each form.
- Referral Form
- Statement of Client Rights and Consent for Treatment
- Estado de Derechos del cliente y Acuerdo para Tratamiento
- Deklarasyon Dwa, Responsablite ak Konsantman pou Tretman Kliyan an
- Authorization for Release of Protected Health Information
- Autorización para Transmitir Información de Salud Protegida
- Otorizasyon pou Pataje Enfòmasyon Medikal ki Pwoteje
- Notice of Privacy Practices
- Aviso de Prácticas de Privacidad
- Client Grievance Form
- Good Faith Estimate Statement
Patient Satisfaction Survey
Your CFSPBC contact will provide the code to access the survey.