Resources

Referral forms for individuals and providers
For general referrals (not from Maine DHHS or Department of Corrections employees)

Primary Care Physician Referral Form (note: we have expanded our web-based referral capacities that results now in the fastest way to submit a referral. Please email Amanda Fitts for more information or to register.)

Central Access Form

Orientation Manual

Nondiscrimination & Accessibility Statement

Orientation Intake Consent for Treatment

HIPAA Consent for Purposes of Treatment

Multisystemic Therapy Referral Screening Form

Notice of Privacy Practices

Children’s Home and Community-Based Treatment Referral Form

For Maine DHHS referrals only:
Consider entering your referral directly online in our secure Access entry system. For more information about this confidential site and to register, please contact Amanda Fitts at afitts@kbhmaine.org

DHHS Office of Child and Family Services Referral Checklist

Please refer to downloadable documents above for Orientation Manual
Intake Consent
HIPAA Consent
Release of Information
Notice of Privacy Practices
Multisystemic Therapy Referral

For Maine Dept. of Corrections referrals only:
Consider entering your referral directly online in our secure Access entry system. For more information about this confidential site and to register, please contact Amanda Fitts at afitts@kbhmaine.org

Department of Corrections (DOC) Referral Checklist

Please refer to downloadable documents above for
Central Access Form
Orientation Manual
Intake Consent

HIPAA Consent
Release of Information
Notice of Privacy Practices
Multisystemic Therapy Referral

Complaint Instructions/Grievance Form

Standards of Conduct/ Corporate Compliance

BPAP Housing Application Form

Shelter Care Plus Application Form

Request for Recovery Coach Services: