Welcome to Optimae Behavioral Health. We look forward to working with you to support you in achieving your health goals. Please see below for:
- forms that are required to be received by your Optimae Behavioral Health office in order to start services
- reference documents
- assessment tools that your provider uses to understand your situation better
If you have any questions about the process of starting care, please contact your local Optimae Behavioral Health office. Please note that during the COVID-19 pandemic, all appointments are delivered via telehealth through video-based or telephonic/telephone platforms.
To download and complete the forms below, please refer to our online guide for filling out and signing documents with Adobe Acrobat Reader.
In order to start services with Optimae Behavioral Health, please download the forms, open with a PDF reader, fill out, sign, and return the documents listed below. Note: To ensure security and privacy, do not complete the forms inside your web browser.
Required Forms (click/tap to download PDF):
If you are unable to print these documents, please call your local Optimae Behavioral Health office and they can be mailed to you. All of these forms must be completed and returned to the office before starting services. If you have any questions, call your local behavioral health office.
- Outpatient Face Sheet (#174), completing highlighted sections
- Sign off Sheet (#159a)
- Provider Collaboration (#131)
- Medication Consent (#120)
- Medication Information Sheet (#117)
- Release of Information Form (#11): Complete one form for each entity to release information to or obtain records from, including your primary care physician, other medical providers, your previous provider, your emergency contact, etc.
Reference (click/tap to download PDF):
Please refer to the following documents, as needed. Let your Behavioral Health office staff know if you would like a hard copy of any of this information and are not able to print it and we can mail it to you.
- Description of Services (#42)
- Privacy Note (#67)
- Informed Consent, Rights, & Responsibilities (#7)
- Informed Consent for Telepsychiatry/Teletherapy (#166)
- Advanced Directives (#136)
- Payment/No shows (#144)
- Grievance and Appeals (#8BH)
The following are tools Optimae providers use for assessment. Please complete and return them if possible (or save to share with your provider). If these forms are upsetting to complete alone, you may complete them with your therapist’s support during sessions. Any done ahead of time will mean less time spent on them during face-to-face time with your therapist, allowing you to start treatment activities sooner:
Adults and Teens (click/tap to access link, then select “down-arrow” icon on upper right to download PDF):
- Customer Intake Form (#178)
- Stress Symptom Checklist (#179A)
- ACEs (#191)
- GAD-7 (#192)
- PHQ-9 (#193)
- CAGE-AID (#199)
Children (click/tap to download PDF):
- Pediatric Symptoms Checklist (#179)
- Childhood Developmental History (#180)
Controlled Substances Agreement:
This agreement explains what Optimae expects when patients are prescribed controlled medications, like stimulants (Adderall and Ritalin for example) and benzodiazepines (like Alprazolam, Clonazepam, and Temazepam). It is to help both you and your provider comply with the law regarding controlled medications, and is essential to the trust and confidence necessary in a physician/patient relationship.