ONLINE FILLABLE FORMS FOR MINOR CHILD
New Minor Child Multi-Part Quick Form
AFTER COMPLETING ABOVE 2 FORMS, PLEASE SUBMIT FOLLOWING DOCUMENTATION
Please submit a copy of identification, insurance card (if unable to upload in the form), Court Parenting Plan if applicable, and any relevant mental health, medical, or educational records (i.e. IEP, Section 504 Plan, FBA/BIP, Neuropsychological or Psychological Evaluation, Test Scores, Report Card) to support care to one of the following:
- Email Forms@orchardhumanservices.org
- Secure Fax (877) 660-8884
- Text 770-686-0894
ADDITIONAL SPECIAL FORMS
AUTHORIZATION
If you are the legal parent/guardian [by law or as appointed by a Judge under a Parenting Plan from Custody Agreement] and wish to provide permission for another adult to participate in your child’s care (such as a step-parent, grandparent, etc.), please complete the following form:
Authorization for Treatment of Minor
AUTHORIZATION & RELEASE FORM
To authorize Orchard Human Services, Inc. staff to share information with a doctor, provider, or other individual, please complete this form with signature and date. Click here to complete form.
FERPA Release Form
To authorize Orchard Human Services, Inc. staff to speak with your school, college, technical school, or university. Click here to complete form.
SAFETY PLAN
Click Here To Access Safety Planning Form
Crisis Support Resources
State Crisis Resources:
- Florida Mental Health Hotline at 866-903-3787
- Georgia Crisis & Access Line 1-800-715-4225
- Virginia Mental Health Hotline at 866-903-3787
National Crisis Resources:
- National Crisis Support Text “HELLO” to 741741
- National Crisis Hotline 1-800-273-8255
- Call 988 (National Suicide Crisis Line)
- Call 911 (Call for Emergency Response)
- Go To Local Emergency Room
Orchard’s Crisis Resources:
- Download “Self-Care Guide” from Orchard’s website:
https://orchardhumanservices.org/wp-content/uploads/2019/04/Self-Care-Guide.pdf
- Contact Orchard Human Services – we offer limited crisis support services:
Text or call (770) 686-0894 [Must Call If After Hours; We Do Not Monitor Texts After Hours]
Fees are discussed on the counseling page; or ask staff for more information.