Emergency crisis response is available 24/7/365. Call 1-866-495-3651

1-866-495-3651

  • Home
  • Appointments
  • Crisis Center
  • Services
    • Outpatient Services
    • Intensive In Home
    • Medication Management
    • Suboxone
    • Substance Use Services
    • Peer Support
    • Community Support Team
    • Groups
    • DWI Services
    • SUD Residential Supports
  • Contact
    • Contact Us
    • Referrals
    • Patient Forms
    • Career Opportunities
    • Become a PSS
    • Get Licensed
    • FAQs
  • ShyasCares
  • Resources
  • Food Pantry
  • Appointments
  • BCri
  • More
    • Home
    • Appointments
    • Crisis Center
    • Services
      • Outpatient Services
      • Intensive In Home
      • Medication Management
      • Suboxone
      • Substance Use Services
      • Peer Support
      • Community Support Team
      • Groups
      • DWI Services
      • SUD Residential Supports
    • Contact
      • Contact Us
      • Referrals
      • Patient Forms
      • Career Opportunities
      • Become a PSS
      • Get Licensed
      • FAQs
    • ShyasCares
    • Resources
    • Food Pantry
    • Appointments
    • BCri

1-866-495-3651

  • Sign In
  • Create Account

  • Bookings
  • Orders
  • My Account
  • Signed in as:

  • filler@godaddy.com


  • Bookings
  • Orders
  • My Account
  • Sign out


Signed in as:

filler@godaddy.com

  • Home
  • Appointments
  • Crisis Center
  • Services
    • Outpatient Services
    • Intensive In Home
    • Medication Management
    • Suboxone
    • Substance Use Services
    • Peer Support
    • Community Support Team
    • Groups
    • DWI Services
    • SUD Residential Supports
  • Contact
    • Contact Us
    • Referrals
    • Patient Forms
    • Career Opportunities
    • Become a PSS
    • Get Licensed
    • FAQs
  • ShyasCares
  • Resources
  • Food Pantry
  • Appointments
  • BCri

Account


  • Bookings
  • Orders
  • My Account
  • Sign out


  • Sign In
  • Bookings
  • Orders
  • My Account

Complete Intake Online

Required Treatment Agreement

Outpatient Services Intake Packet

Outpatient Services Intake Packet

Modified Intake Packet

Outpatient Services Intake Packet

Outpatient Services Intake Packet

Outpatient Services Intake Packet

The complete Intake Packet complete packet 1 and packet 2

Controlled Substance Agreement

Outpatient Services Intake Packet

Consent to Release and Exchange Information

Suboxone/Buprenorphine Patient Form

Consent to Release and Exchange Information

Consent to Release and Exchange Information

Consent to Release and Exchange Information

Permission to Communicate with Others Regarding Your Care

DWI Intake Packet

Consent to Release and Exchange Information

Residential Recovery Supports Intake Packet

Complete Intake Packet for ADETS, Short Term Treatment, Long Term Treatment, IOP or Residential Treatment

Residential Recovery Supports Intake Packet

Consent to Release and Exchange Information

Residential Recovery Supports Intake Packet

Complete SHYAS CARES Intake Packet for  Residential Recovery Supports Program Phase 1 and Phase 2

Download Intake forms

SHYAS 2023 Intake (pdf)

Download

Required Treatment Agreement (pdf)

Download

Controlled Substance Agreement (pdf)

Download

Consent to Release and Exchange Info (pdf)

Download

New Patient Questionnaire (pdf)

Download

Patient Follow Up Form (pdf)

Download

Copyright © 2007 S&H Youth and Adult Services, Inc. - All Rights Reserved.

Powered by

  • Appointments
  • Crisis Center
  • Outpatient Services
  • Intensive In Home
  • Medication Management
  • Suboxone
  • Substance Use Services
  • Peer Support
  • Community Support Team
  • SUD Residential Supports
  • Referrals
  • Patient Forms
  • Career Opportunities
  • Get Licensed
  • Employee Home Page
  • ShyasCares
  • Resources
  • Calendar
  • Food Pantry

Cookie Policy

This website uses cookies. By continuing to use this site, you accept our use of cookies.

Accept & Close