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



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

National Suicide Prevention Lifeline
800-273-8255 ext 1 Toll free

For Military and Veterans
Chat online at
Text message to 838255
In Europe call 00800 1273 8255 or DSN 118
Visit website of veterans affairs for Resource Locator

Summit County Developmental Disabilities Board
877-271-6733 toll free 24 hour crisis line or 330- 634-8000

Trevor Project
866-488-7386 Toll free,  Trevor Helpline 1-866-4-U-TREVOR

Crisis line for LGBTQ Youth

Trans Lifeline
Hotline for transgender people experiencing crisis, hotline run by transgender people
If unsure whether to call or not, Call!

Text Crisis Hotline - text version

Nami Information Line