Coastal Mental Health Center

Coastal Mental Health CenterCoastal Mental Health CenterCoastal Mental Health Center

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COVID-19
Documentation
Staff
Services
Insurances
Contact Us
Additional Resources
More

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

Authorization for Treatment (pdf)Download

General Affidavit (pdf)Download

HIPAA NOTICE OF PRIVACY RIGHTS (pdf)Download

Bill of Rights (pdf)Download

Patient Rules and Regulations (pdf)Download

Insurance Statement (pdf)Download

NO Show fee notice (pdf)Download

PCP Consent (pdf)Download

Consent for Telehealth (pdf)Download

Electronic Authorization to Release (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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