Forms
On this page you'll find various forms for your review and reference. To save on paper, select the option on your printer to print on both sides of the sheet.
Below these forms is also a list of Crisis Hotline numbers.
Release of Information
Electronic Policy Page
Anxiety & Depression Inventory
Client Information
Consent to Treat
Professional Disclosure Statement
Policies
Adult Intake Form
Child & Adolescent Intake Form
Crisis Hotline Numbers
Portage Path Behavioral Health Crisis Intervention Hotline (adults)
330-434-9144 or 800-273-TALK
Free and confidential 24 hour support hotline for people struggling with mental health issues. Provides crisis intervention and suicide prevention.
Child Mental Health Emergencies Children’s Hospital PIRC program (children)
330-543-7472 or Toll free 1-866-443-7472
Oriana House Hotline for Alcohol and other Drug Emergencies
330-996-7730
National Suicide Prevention Lifeline
800-273-8255 ext 1 Toll free
For Military and Veterans
Chat online at www.veteranscrisisline.net
Text message to 838255
In Europe call 00800 1273 8255 or DSN 118
Visit website of veterans affairs www.veteranscrisisline.net for Resource Locator
Summit County Developmental Disabilities Board
877-271-6733 toll free 24 hour crisis line or 330- 634-8000
www.summitdd.org
Trevor Project
866-488-7386 Toll free, Trevor Helpline 1-866-4-U-TREVOR
Crisis line for LGBTQ Youth
www.thetrevorproject.org
info@thetrevorproject.org
Trans Lifeline
Hotline for transgender people experiencing crisis, hotline run by transgender people
If unsure whether to call or not, Call!
877-565-8860
Text Crisis Hotline - text version
741741
Nami Information Line
800-950-NAMI