Coastal Mental Health Center

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

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
  • Privacy Policy

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

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
Patient Rules and Regulations Spanish (pdf)Download

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