Intake Forms

If you are preparing for your first visit to New Oakland, please click the links below to download the forms you should complete before your visit. Once you have downloaded them, you can print them at any home or office. However, if you can’t print forms, they will also be available for you to complete when you arrive at New Oakland. (Please note: if you plan to complete forms on a mobile device, you must first open them with the Adobe Acrobat Reader mobile app, available via the Apple App Store or Google Play. Forms opened with any other PDF reader will not be able to be completed on a phone or other mobile device.)

 

Before your first telephone or televideo intake appointment, please click the link below to download the one-page telehealth/treatment/billing consent form you should complete before your appointment.

CLICK HERE TO DOWNLOAD THE TELEHEALTH/TREATMENT/BILLING CONSENT FORM (1 page)

 

For the packet of forms for outpatient services, please click the link below to download the forms you should complete before your visit.

CLICK HERE TO DOWNLOAD OUTPATIENT FORMS (8 pages)

 

For the packet of forms for our FACE to FACE (PHP) program, please click the link below to download the forms you should complete before your visit.

CLICK HERE TO DOWNLOAD FACE TO FACE (PHP) FORMS (12 pages)

 

 

Release of Information Form

If you are requesting that we share your health records with another provider, you will need to complete an Authorization to Release Confidential Information form and return it to New Oakland. You can access the form by clicking the link below:

CLICK HERE TO DOWNLOAD THE AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION (1 page)

 

 

Trauma Evaluation Caseworker Form

If you are a caseworker preparing background for a new Trauma Evaluation program participant, you will need to complete this Trauma Assessment Referral form. You can access the form by clicking the link below:

CLICK HERE TO DOWNLOAD THE TRAUMA ASSESSMENT REFERRAL FORM–MDHHS-5594 (5 pages)