Forms – Child

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ONLINE FILLABLE FORMS FOR MINOR CHILD

New Minor Child Multi-Part Quick Form

Appointment Policy

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:

  1. Email Forms@orchardhumanservices.org
  2. Secure Fax (877) 660-8884
  3. 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.

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