Coastal Mental Health Center

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    • Home Page
    • COVID-19
    • Documentation
    • Staff
    • Services
    • Insurances
    • Contact Us
    • Additional Resources

Coastal Mental Health Center

Coastal Mental Health CenterCoastal Mental Health CenterCoastal Mental Health Center
  • Home Page
  • COVID-19
  • Documentation
  • Staff
  • Services
  • Insurances
  • Contact Us
  • Additional Resources

Medical Records

Send completed forms to  medicalrecords@coastalmhc.com

FORMS

Vanderbilt Adult (pdf)Download
Vanderbilt English Parent (pdf)Download
Vanderbilt Spanish Parent (pdf)Download
Vanderbilt English Teacher (pdf)Download

Documents English

Patient Rules and Regulations (pdf)Download
Authorization for Treatment (pdf)Download
Bill of Rights (pdf)Download
HIPAA NOTICE OF PRIVACY RIGHTS (pdf)Download
PCP Consent (pdf)Download
Consent for Telehealth (pdf)Download
Electronic Authorization to Release (pdf)Download
General Affidavit (pdf)Download
Guarantor (pdf)Download
Health Care Surrogate for Minor (pdf)Download

Site Content

Enviar los documentos completados a medicalrecords@coastalmhc.com

Documents Spanish

Patient Rules and Regulations Spanish (pdf)Download
Authorization for Treatment in Spanish (pdf)Download
Bill of Rights Spanish (pdf)Download
Mental Health Treatment Authorization Form - Spanish (pdf)Download
Health Care Surrogate for Minor - Spanish (pdf)Download

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Announcement

Now accepting Advent Health with Optum Insurance