Search Drug and Alcohol Services Consent Forms


Forms & Documents > Drug and Alcohol Services Consent Forms

Name Description Type
Consent_Criminal_Justice_English 04-27-2021 DAS Consent Form - Criminal Justice Use this form for clients that are court-ordered into treatment. File
Consent_Criminal_Justice_Spanish_03-15-2021 DAS Consent Form - Criminal Justice Use this form for clients that are court-ordered into treatment. File
Consent_Multi-Purpose_English-Rev-06-01-21 DAS Consent Form - Multi Purpose: Use this form for most clients that are not court-ordered into treatment. Used for sharing and disclosing of health information to allow coordination of care/Treatment/Referrals between any NON-treatment provider. File
Consent_Multi-Purpose_Spanish_06-03-21 DAS Formulario de consentimiento de uso multiple - Use esta forma para la mayoría de los clientes que no están ordenados por la corte para recibir tratamiento. Por defecto es para todos los propósitos y toda la información del cliente. File
Consent_Joint_Records_English Rev 06-01-21 DAS Consent Joint Records (Revised 06-01-21): Use this form for ongoing disclosure and sharing of health information to allow coordination of care between any treatment provider. File
Consent_Billing_English_01-01-2021 Use this form to allow San Luis Obispo County Behavioral Health to bill insurance carrier or other payer to obtain payment/reimbursement for care File
Consent_Billing_Spanish_01-01-2021 Use this form to allow San Luis Obispo County Behavioral Health to bill insurance carrier or other payer to obtain payment/reimbursement for care File
Consent_Joint_Records_Spanish_06-03-21 DAS Consent Joint Records (Revised 06-03-21): Use this form for ongoing disclosure and sharing of health information to allow coordination of care between any treatment provider. File
Universal-815-Form-with-Fax-Cover English Universal-815-Form-with-Fax-Cover English Link
Universal-815-Form-with-Fax-Cover_SPANISH_03-07-18 Form 815 - Spanish Version File
Consent_Probation_Initial_Referral_-For-Probation-Dept-Use-Only-_-03-09-18 DAS Probation Department Initial Referral Consent - This consent is only to be used by Probation Department when referring clients to DAS. File

Please contact our access line at 1 (800) 838-1381 for information or to schedule an appointment. All services are available in Spanish.