eBIP - Enhanced Behavioral Information Program

Referral Forms

Below you will find links to various forms you may be asked to sign before we can provide service to you. Copies of these forms are also available in our office locations.

TCRC Agency Forms:

TCRC Referral for Behavioral Services
TCRC Background Information On When Problems Occur
TCRC Information On What We Do and Don't Provide
TCRC Available Meeting Times
TCRC-ASD Referral Form
Consent to Use and Disclose Health Information
HIPAA Authorization to Exchange Information
Satisfaction Survey for Consumers
Behavioral Services Information Sheet

CVRC Agency Forms:

CVRC Referral for Behavioral Services
CVRC ASD Referral for Behavioral Services
Consent to Use and Disclose Health Information
HIPAA Authorization to Exchange Information
Satisfaction Survey for Consumers
Behavioral Services Information Sheet

KRC Agency Forms:

Kern Vendor Referral Form
Consent to Use and Disclose Health Information
HIPAA Authorization to Exchange Information
Satisfaction Survey for Consumers
Behavioral Services Information Sheet

En Espanol:

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