Client Forms

**These releases are to be completed with SATUCI staff.

SATUCI Tele-Health Consent

SATUCI Consent to Treat/Paysource

SATUCI Consent to Release Information (For family, attorneys or other supports)

DOC—SATUCI Consent to Release Information (For probation/parole officers and Juvenile Court officers)

SATUCI Consent General Release To and From (For mental health counselors, doctors, residential treatment & other healthcare providers)

DHS—SATUCI Consent to Release Information (For all DHS workers & FSRP workers)

Clerk of Court—SATUCI Consent to Release Information (For the county of where you were charged/civil committal)

Multi Residential Referral To and From Release

Consent to Release of Alcohol and/ or Drug Treatment Information (OWI / 321J)

Intent/Consent to Treat