Get Gosh Enrollment Form - Richland Mental Health And Recovery ...

Completing the GOSH Enrollment Form is a crucial step for individuals seeking mental health and recovery services. This guide provides detailed instructions to help you successfully fill out the form online.

Follow the steps to complete the GOSH Enrollment Form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Identify if you are a new member or making a change/update by selecting the appropriate option.
3. Fill in your submitting provider's information, including contact person, agency type, and ensure to provide the correct fax and phone numbers.
4. Complete the client information section, starting with your last name, first name, middle initial, date of birth, and gender.
5. Enter your full address, including address line one and two, city, state, zip code, and county.
6. Provide your home and business phone numbers, then select your race and ethnicity from the options provided.
7. Indicate your marital status and provide your Medicaid number, social security number, client ID, start date, and family size.
8. Document your monthly income and any relevant insurance information.
9. Indicate whether disclosures and consent forms have been signed with a 'Yes', 'No', or 'Unknown' selection.
10. If applicable, note if you are in crisis at enrollment and add any relevant comments in the provided section.
11. Once all fields are completed, review your information for accuracy. Save your changes, download, print, or share the form as needed.

Begin completing your GOSH Enrollment Form online today to ensure you receive the support you need.