Client Forms

As a client of Canvas Health, you are entitled to certain rights regarding your care and information. Please view the following videos for more information.

• How to Request Amendments
• Your Health Information Rights
• How to Access your Health Information
• Canvas Health Patient Bill of Rights
• Client Informed Consent
• Client Emergency Contact Form

• Release of Information Form
• Customer Satisfaction Survey

• Adult Day Treatment/Group Therapy Referral Form
• Children’s Case Management Referral Form
• Children’s Therapeutic & Support Services Referral Form
• Circle of Security Referral Form
• Early Childhood Behavior Assistance Referral Form
• Family Treatment Program Referral Form – Washington County Only 
• In-Home Skills Referral Form – Washington County Only
• Partnering for Jobs Referral Form
• Psychological Services Request for Assessment Form
• Therapeutic Learning Center (TLC) Referral Form
• Therapeutic Education Collective (TEC) Referral Form

Please print, complete, and bring these materials to your appointment

• Client Information Packet

Please print, complete, and bring these materials to your appointment

• Client Information Packet

Please print, complete, and bring these materials to your appointment.

• Client Information Packet

• Client Information Packet – Spanish 
• Nondiscrimination Notice – Spanish
• Patient Bill of Rights – Spanish
• Reminder Information – Spanish