South Coast Community Services

Mental Health Therapy, Suicide Prevention, and Residential Services

For kids, youth, adults, and their families

Forms

REFERAL FORM for Schools, etc.

Consent Packet - Minors

Consent Packet - Minors - Spanish

https://southcoast.formstack.com/forms/consent_for_treatment_for_children_spanish

Consent Packet - Adults

Pediatric Symptom Checklist

https://southcoast.formstack.com/forms/pediatric_symptom_checklist

Client Satisfaction Survey

https://southcoast.formstack.com/forms/client_satisfaction

Authorization to Release PHI

https://southcoast.formstack.com/forms/authorization_for_release_of_phi_and_amr

Consent Packet - Adults

https://southcoast.formstack.com/forms/consent_for_treatment_for_adults_spanish

Adult Symptom Checklist

https://southcoast.formstack.com/forms/pediatric_symptom_checklist

SAP Registration Form

https://southcoast.formstack.com/forms/student_assistance_program_registration_form_english

Change of Provider Request Form - SB County

https://southcoast.formstack.com/workflows/change_of_provider_request_form_workflow

SB Wrap CFS Grievance Procedures

Complaint & Grievance Procedure - English

DBH Grievance Form - Spanish

Complaint & Grievance Procedure - Spanish

hthttps://www.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=7daec9d7-9aea-4206-8088-57989bb805c0&env=na1&acct=723a7c48-0020-455a-b79d-6bdc4641d50c&v=2