*** Forms for Bluestem Patients Only ***

New Patient Paperwork ‐ Kids 11 and Under

Please check with Bluestem prior to completing any New Patient Paperwork.

Patient PORTAL Sheet

Patient Information and Policies Brochure

Patient Information Sheet

Minor Clients Policy

Authorization for Treatment of Minors (Signatures)

Financial Policy

Notice of Privacy Practices

 

New Patient Paperwork- Adolescents 12 and over

Please check with Bluestem prior to completing any New Patient Paperwork.

Patient PORTAL Sheet

Patient Information and Policies Brochure

Patient Information Sheet

Minor Clients Policy

Authorization for Treatment of Minors (Signatures)

Adolescent Confidentiality Form: Teen Version

Adolescent Confidentiality Form: Parent Version

Understanding of Confidentiality Agreement (Signatures)

Financial Policy

Notice of Privacy Practices

 

New Patient Paperwork- Adults

Please check with Bluestem prior to completing any New Patient Paperwork.

Patient PORTAL Sheet

Patient Information and Policies Brochure

Patient Information Sheet

Financial Policy

Notice of Privacy Practices

 

Other Forms

Adolescent Confidentiality Agreement - Parent Version

Adolescent Confidentiality Agreement - Teen Version

CNHI Adult

CNHI Child

Medication Auth Form

POQP PDF

Release of Information - Bluestem Form

Release of Information - Mayo Form

Release of Information - Olmsted Form

School & Behavior Problems Checklist- For Teachers

Understanding of Confidentiality Agreement

Vanderbilt-Parent Informant

Vanderbilt Assessment Scale for Teachers

YPQ (11 and under)

YPQ (12 and older)