Behavioral Health Transfer Forms

If you are a facility who is transferring a patient to Kootenai Health’s Behavioral Health program, please use the forms listed below.

For Youth Transfers:

Youth Transfer Request

• Youth Transfer Request Form
• Telehealth Consent Form

Admission Packet

• Patient Intake Form
• Acknowledgement of Custody and Consent for Discharge
• Medical History Questionnaire
• Release of Information
• Conditions of Admission to Kootenai Health
• Youth Communication List

Family Information Packet

• Child (6-13 Years)
• Adolescent (14-17 Years)

For Adult Transfers

Coming Soon