Client Forms, Mental Health Intake Forms

Referrals & Appointments

If you would like to request an appointment at Canvas Health for yourself or a family member, click here.
If you are a professional and would like to make a referral to Canvas Health, click here.

Client Portal

If you are a current Canvas Health client (18+), and would like to have access to our Client Portal to complete intake and other forms, please speak with your provider. Thank you!

If you are already signed up for the Client Portal, please click here to login.

Bill of Rights, Release of Information, Program Referral Forms, and Other Info

Please see below for client bill of rights, referral forms, and other information.

Client Rights

As a client of Canvas Health, you are entitled to certain rights regarding your care and information. Please view the following videos for more information.

How to Request Amendments
Your Health Information Rights
How to Access your Health Information
Canvas Health Patient Bill of Rights
Client Informed Consent

Client Release of Information

Release of Information Form – English
Release of Information Form – Spanish

Referral Forms

Adult Day Treatment/Group Therapy Referral Form
ARMHS Referral Form
Children’s Case Management Referral Form
Children’s Therapeutic & Support Services Referral Form
Circle of Security Referral Form
Early Childhood Behavior Assistance Referral Form
Family Treatment Program Referral Form – Washington County Only
In-Home Skills Referral Form – Washington County Only
Partnering for Jobs Referral Form
Psychological Services Request for Assessment Form
Therapeutic Learning Center (TLC) Referral Form

Formularios en Español

Patient Bill of Rights – Spanish

Client & Referral Forms

Referrals & Appointments

Client Portal

Bill of Rights, Release of Information, Program Referral Forms, and Other Info

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You are welcome at Canvas Health. We're looking forward to serving you.

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