Behavioral Health Forms & Screeners
ACE Screener
Adverse Childhood Experiences screener for assessing early trauma exposure.
Case Conference Review Record
Document used to review and record interdisciplinary case discussions.
Case Management Needs Assessment
Assessment form used to identify and document case management needs.
CATS Screener Caregiver (Ages 3–6)
Caregiver screener for trauma symptoms in children ages 3–6.
CATS Screener Caregiver (Ages 7–17)
Caregiver screener for trauma symptoms in children ages 7–17.
CATS Screener Youth Report (Ages 7–17)
Self-report screener for youth ages 7–17 experiencing trauma symptoms.
IEP Attestation for PICIS
Form to verify a client’s Individualized Education Plan for PICIS eligibility documentation.
No Harm Contract & Safety Plan
Client agreement used to commit to safety during emotional crises.
OKBH Consents
Consent forms required for services at OKBH.
OKBH Psych Social
Psychosocial form for intake assessments and background information.
Pediatric Symptom Checklist-17
Brief screening tool used to recognize cognitive, emotional, and behavioral problems in children.
PHQ-9
Patient Health Questionnaire-9 used to screen, diagnose, and measure severity of depression.
PTSD Screener PCL-5
PTSD self-assessment tool (PCL-5) for use with teens or adults experiencing trauma symptoms.
Release from School or Daycare
Authorization form for client early release due to behavioral health needs.
Release of Confidential Information
Authorization form to release client’s confidential health records.
Risk Assessment
Tool used to evaluate client safety risks, including suicide or harm to others.
Smoking Cessation Form
Support tool for clients working to quit smoking, includes quit plan.
Statement of Disclosure – LADC
Statement of professional disclosure form for licensed alcohol & drug counselors in Oklahoma.
Statement of Disclosure – LADC Candidate
Statement of professional disclosure form for LADC candidates practicing under supervision.
TB Screening
Form for screening risk factors or symptoms related to tuberculosis.
Treatment Advocate Form
Form to designate someone as a treatment support or advocate.
Corporate Forms
Adverse Incident Report
Report safety or workplace-related incidents quickly and confidentially.
Client Grievance Form
Use this form to formally submit any client complaints or concerns.
General Request Form
Request time off, pay raise, reimbursements, repairs, or more.
Mileage Request Form
Submit travel miles for work-related reimbursement.
Weekly Time Sheet
Track and report weekly work hours for payroll or contract tracking.