Resources and Forms

General Forms

• Request to Inspect and/or Receive Copies of Clinical Record
• Incident Report Form
• Emergency Use of Physical Management Form
• OnPoint Sliding Fee Scale
• Internal Service Rates

If you are uninsured or underinsured, you may be eligible for financial assistance under the Federal Poverty Guidelines (FPG).  The scale is based on gross income and family size. Depending on where you fall on the scale will determine what your monthly ability-to-pay will be, if eligible.