Forms for Referral / Admissions
To refer a child to Orchard Place, the Campus Application Bundle needs to be completed by the parent or guardian.
CAMPUS FORMULARIO DE ACCESO
EXAMEN DE SALUD
AUTORIZACIÓN PARA LA DIVULGACIÓN DE INFORMACIÓN
AUTORIZACION PARA REVELAR INFORMACION PROFESIONAL DE USO DE SUSTANCIAS
INFORMACIÓN DE SEGUROS PARA EL LUGAR
ACUERDO FINANCIERO DE PRE-ADMISIÓN
The Authorization for Release of Professional Information forms must be completed for current and previous treatment or services provides as well as your child's school. The form allows us to obtain records for the child. Please complete one for each professional or agency who has worked with the child including the county DHS office (i.e. Polk County DHS) or Juvenile Court Office (i.e. Warren County Juvenile Court). They are considered the individual / agency. You may also sign a release at the office of the other treatment provider. Records can be faxed or mailed to us. Please visit our contact page for details.
For additional information, please refer to the forms below:
Funding for Services
The Orchard Place Campus Family Handbook helps parents understand more about policies and treatment programs we offer. We also know it can be difficult for parents, as they rightfully have many questions about guidelines. This document helps families understand the pre-admission process, family involvement, and your rights when it comes to utilizing Orchard Place Services.
The Orchard Place Resident Handbook describes what life is like on the Orchard Place Campus and includes guidelines, so all residents are safe and secure while at Orchard Place.