We have merged with Valley-Wide Health Systems, Inc.
Our services will continue to be provided as before merger.
Now you will have expanded access to our combined services.
With the merger, this website will soon be closing down.
Don't worry! Just go to valley-widehealth.org where you'll find what you're looking for.
General Forms
Authorization for Release of Information
Authorization for Release of Information en Esphañol
Protected Health Info Request: Individual
Protected Health Info Request: Agency
Records Request: Primary Care/PT
Client Rights & Responsibilities: SHG
Client Rights & Responsibilities: SHG en Esphañol
Client Rights & Responsibilities: WW
Mandatory Disclosure: SHG en Esphañol
Mandatory Disclosure: WW/Regis
Limits of Confidentiality en Esphañol
Payment Agreement Financial Disclaimer
Payment Agreement Financial Disclaimer en Esphañol
Privacy Practices en Español: SHG
Privacy Practices: Primary Care
Privacy Practices en Español: Primary Care
Protected Health Information Request Agency
Protected Health Information Request Individual
Out-of-State Offender Forms
Notification of out-of-state offender placement
Form B
Out-of-state offender client questionnaire
Form C
Notification of out-of-state offender
Online Intake/Update Forms
Easily Access our services by calling 1-800-511-5446, or walk into one of our offices near you. No hassle, technology support available if needed.
If you need assistance with the forms or have questions, please call us or click the Help button below.
You may refer to the Forms on the left side of the page as you complete the Online Forms.
Authorization for Release of Information
Acknowledgement/Consent to Treat
Psychiatric Services “No-Show” Policy
Coordination of Care - Information Request
SEMHS Acknowledgement of Treatment
SHG Ethical and Confidentiality
For assistance with other questions, please call us at 1-800-511-5446