Get Information Form - Behavioral Health Care Services - Acbhcs

Completing the Information Form for Behavioral Health Care Services is an essential step for those seeking mental health housing assistance. This guide provides clear instructions to help you navigate the form accurately and efficiently.

Follow the steps to complete the Information Form online

1. Press the ‘Get Form’ button to access the Information Form for Behavioral Health Care Services. This will allow you to open the document in an editor for completion.
2. Begin by filling in your full name as the applicant in the designated field. Ensure that you provide accurate details including any middle names or suffixes.
3. Provide the date on which you are completing the application in the ‘Date Application Completed’ field. Ensure to use the format Month/Day/Year.
4. Enter your date of birth in the specified section using the format Month/Date/Year.
5. Input your Social Security number in the required field. Note that this information is used solely for searching BHCS records.
6. Fill in your current contact address, including city and zip code, if applicable. If you are homeless, provide information on your current location if applicable.
7. List your current contact phone number, if applicable, ensuring that it is reachable for further communication.
8. In the consent section, provide the names and contact information of any providers you authorize BHCS Staff to communicate with regarding your application.
9. Sign and date the application to authorize the release of your information, confirming that the details provided are accurate.
10. Complete the homeless verification section by checking the appropriate box that applies to your current housing situation and attach the necessary documentation as specified.
11. Double-check all provided information for accuracy before submitting the form.
12. Once completed, you can save your changes, download a copy of the form, or print it. Subsequently, submit the form and additional documents via mail or fax to the provided addresses.

Encourage others to complete their Information Form online for Behavioral Health Care Services.