CAPS Forms

These are the forms used by CAPS to initiate treatment, obtain or release records, and bill insurance. Use the boxes below to find the forms you're looking for:

When a student is a minor, we need the following forms completed by a parent/guardian for CAPS treatment. Please also review our instructions for accessing services for students who are under 18.

Forms:

Consent to Treat a Minor

Consent to Treatment

Authorization to Bill Insurance

Telebehavioral Health Services Consent Form

The following forms are used to give CAPS permission to request or release your records: 

CAPS Authorization for Release of Information (Allows CAPS to RELEASE information to an outside provider)

CAPS Authorization to Request Information (Allows CAPS to REQUEST information from an outside provider)

Permission for Telephone Consult/Release of Information via Telephone (Allows CAPS to speak with someone about you and your treatment at CAPS via phone)

In order to receive medication treatment for ADHD, the following packet will need to be completed and reviewed by the psychiatry team before an appointment can be made:

ADHD Information Packet

Find out more about our ADHD Services.