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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

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 Intake Packet for  Long Term Residential Treatment 

Download Intake forms

SHYAS 2021 Intake online (pdf)

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Required Treatment Agreement (pdf)

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Controlled Substance Agreement (pdf)

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Consent to Release and Exchange Info (pdf)

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New Patient Questionnaire (pdf)

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Patient Follow Up Form (pdf)

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  • Outpatient Services
  • Long Term Treatment
  • Foster Care
  • Suboxone
  • Substance Use Services
  • Peer Support
  • Medication Management
  • Referrals
  • Patient Forms
  • Career Opportunities
  • Get Licensed
  • Employee Home Page
  • Pay Here
  • ShyasCares
  • Resources
  • Calendar
  • Food Pantry