Forms, Information, Resources – Orchard Human Services, Inc.

Please click on the links below to download forms and resources.

Self-Care Guide – a thin book to help you through a rough patch in life:

FORMS for care of a child or minor:

You have 3 choices for submitting information for new client appointments.

Online Quick Form – Fillable Multi-Part Form
Online Individual Fillable Forms
Individual PDF Downloadable Forms to Complete on Paper

Online Quick Form – to make it easier for parents to complete online information in one seamless process. If you choose this option, you may have to upload or submit additional information separately:

New Minor Child Multi-Part Quick Form

Online Individual Forms – You can complete each online form, one at a time, to allow for more comprehensive information. You may have to upload or submit additional information separately:

Individual Online Fillable Minor Client Form Under Construction
Individual Online Fillable HIPAA Privacy Form
Individual Online Fillable Telemental Health Permission Form
Individual Online Fillable Consent for Third Party Billing
Individual Online Fillable Authorization for Treatment of Minor

Individual PDF Downloadable Forms – Download each individual form, print on paper, fill out by hand, and fax or scan back. Email forms and documents back to Forms@OrchardHumanServices.org or fax to 877-660-8884.

Downloadable PDF Child-Intake-Form
Downloadable PDF HIPAA Privacy Form
Downloadable PDF Telemental Health Permission Form
Downloadable PDF Consent for Third Party Billing … If you have insurance or any other party is paying for your care, please complete the form.
Downloadable PDF Authorization to Provide Treatment to a Minor … Please complete if you want us to discuss your child’s care with another adult, or have another adult access or participate in services for your minor child. For example, if you are the parent** who has legal authority to make decisions on behalf of your child, please complete this form if you want us to also discuss your child’s case with your co-parent, partner, grandparent, or other adult.

**If custody of the child has been ordered by a court, please also submit a COPY of the Court Ordered Custody Agreement with Parenting Plan so we know we have the appropriate permission to provide services to your child.