Forms
Help us find the right place for you.
The easiest way to get started with Veritas is to give us a call at 855-875-5812. Our Admissions Team can answer your questions and, if you’re ready, collect the information we need to begin the admissions process.
Once you’ve started the process, you may be asked to complete some forms to help facilitate treatment. Below are our commonly requested forms. If you have questions about how to complete the forms, our Admissions Team can help.
To fill out and submit forms online, download the With Me When App.
General Forms
- Request for Records: Complete this form if you would like your records to be sent from Veritas Collaborative to another party. The completed form will be kept on file for additional future use.
Go to form - Release of Information Form: This form gives us permission to talk to your doctors, family members, and others you would like to have involved with your care. Please submit one form for each person. Complete this form if you are new to Veritas Collaborative, or if you simply want an ROI on file for future use.
Download PDF - Financial Release of Information: This form documents your consent for Veritas Collaborative to share information regarding your treatment to your insurance provider.
Download PDF - Insurance Verification Tool: It’s important that you understand the services that your insurance will cover. We’ve created the below tool to help guide you through the insurance verification process. This tool includes everything you will need to have ready for the phone call and every question to ask the insurance representative about your coverage.
Download PDF - Notice of Privacy Practices: This notice describes how clinical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Download PDF
Intake Documents
Complete these forms prior to your intake appointment.
- Intake Packet (English Version): Download PDF
- Intake Packet (Spanish Version): Download PDF
Filing a Grievance
In order to guarantee clients a means to express their concerns, to ensure the integrity of service, and to preserve the positive therapeutic environment that Veritas Collaborative strives to provide, Veritas Collaborative has instituted a grievance policy and form. Veritas Collaborative will work with clients, their parents or legal guardians and all other involved team members, outside agencies or providers, and staff to actively and objectively address client complaints or grievances (“grievances”) regarding any aspect of care. Please review the Grievance Policy below. Complete and submit the Grievance Form.
- Grievance Process: Download PDF
- Grievance Form: Download PDF