Forms

Client Rights
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

Client Forms
To open and print our forms, you must have a PDF viewer installed on your computer. Download Adobe Reader free of charge. If you have questions, please contact us at (651) 777-5222.

Release of Information Form

Client Acknowledgement Form

Telehealth Acknowledgement Form

Unsecure Data Consent Form

Telehealth Agreement

E-Signature Agreement

Adult Day Treatment/Group Therapy Referral Form

Early Childhood Behavior Assistance Referral Form

Psychological Services Request for Assessment Form

Customer Satisfaction Surveys

Children’s Case Management Referral Form

Adult/Child Mental Health and Substance Use – Spanish Forms