If you are a facility who is transferring a patient to Kootenai Health’s Behavioral Health program or a family member of a patient being transferred, please use the relevant forms listed below.

For Youth Transfers:

Transfer Request Form (for facilities that are transferring a youth)

• Youth Transfer Request Form

Admission Packet (for families to complete)

• Patient Intake Form
• Acknowledgement of Custody and Consent for Discharge
• Medical History Questionnaire
• School Release of Information
• My consent to Medical Care
• Youth Communication List
• Family Expectations Evaluation

Information for families (about the unit your child is going to)

• Child Family Packet (13yrs and under)
• Adolescent Family Packet (14yrs and over)