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Forms

Heartland Client History Form

Heartland Client History Questionnaire

Heartland Child History Questionnaire

Heartland Client History Questionnaire (Spanish)

Heartland Child History Questionnaire (Spanish)

Release of Information Forms

Authorization for Release - Adult Support Services

Authorization for Release - Outpatient

Authorization for Release - Youth Care

Referral Forms

Community Support Referral Form

Emergency Support Referral Form

Youth Care Coordination Referral Form

Opioid & Substance Use Referral Form

Day Support Referral Form