Orchard · Forms
Start here — we’ll guide you to the right forms for your situation
Who needs services?
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Need help? Call (770) 686-0894 or email Forms@OrchardHumanServices.org
No Surprise Act Notice & Consent
Required if you do NOT have insurance paying for your care
The No Surprise Act applies to clients who pay for their care directly, without insurance. If you are paying out-of-pocket, federal law requires that you receive this notice and consent. Orchard complies with the 2022 No Surprise Act to the extent allowed by law and ethical standards of practice. Please ask our staff if you have questions.
Complete the Required No Surprise Act Notice & Consent Online →
Everyone completing the No Surprise Act form must also download these documents for their records:
New Client Forms — Child
Choose the option that works best for you
Quick Form — All-in-One
Complete parent intake in one seamless process. You may be asked to upload additional information separately.
Online Fillable — One at a Time
Complete each form individually for more comprehensive information.
» Minor Client Form — under construction
» Telemental Health Permission
» Consent for Third Party Billing
Only if you cannot use the online fillable forms
Download, print, complete by hand, then fax to 877-660-8884 or email to Forms@OrchardHumanServices.org
Custody Note: If custody has been ordered by a court, please also submit a copy of the Court Ordered Custody Agreement with Parenting Plan so we have appropriate permission to provide services.
New Client Forms — Adult
Complete these forms online — it’s the fastest path to your first appointment
Complete these forms online
Guardian of an adult, or an adult authorizing someone else to be involved in your care?
Complete the Adult Authorization Form →
Only if you cannot use the online fillable forms
Download, print, complete by hand, then fax to 877-660-8884 or email to Forms@OrchardHumanServices.org
Additional Forms & Releases
Use these as needed — in addition to your intake forms
Authorization & Release Form
To authorize Orchard staff to share information with a doctor, provider, or other individual.
FERPA Release Form
To authorize Orchard staff to speak with your school, college, technical school, or university.
Self-Care Guide
A thin book to help you through a rough patch in life
Download the Self-Care Guide →If you are in danger or crisis, please call 911 or go to the nearest emergency room immediately.
Need crisis resources for later use?
Call (888) 263-1986 and our system will automatically text you crisis resources, referrals, and valuable information. Your information is confidential — we only respond to your request for resources.
Questions about fees? They are discussed on the counseling page, or ask our staff for more information.