ADDITIONAL FORMS

Individual Service
Plan Acknowledgement
Release of Information
Consent for Alcohol-Drug Testing
Controlled Medication Contract
Demographic Form
Patient’s Rights & Responsibilities
Notice of Privacy Practices
Revocation of Release
of Information
Contact & Insurance
Information
Recipient Rights Complaint
Intern Consent

Lakes Region Mental Health Center provides comprehensive, integrated mental health treatment for people living with – and recovering from – mental illness and/or emotional distress.

info@lrmhc.org

General: 603-524-1100 Emergency: 833-710-6477

© (2022) Lakes Region Mental Health Center..