Referral forms and documents
For general referrals (that is, not from Maine DHHS or Department of Corrections employees)
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Primary Care Physician referral form: Word document A note to Primary Care Physicians: We have expanded our web-based referral capabilities that results now in the fastest way to submit a complete referral. For more information about this, or to become a registered user, please e-mail Amanda Fitts at afitts@kbhmaine.org.
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Orientation manual: pdf
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Nondiscrimination and Accessibility Statement: pdf
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Orientation intake consent for treatment: Word document
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HIPAA consent for purposes of treatment, payment and operations: Word document
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Compliments Kudos Form Download and e-mail to info@kbhmaine.org
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Complaint/Grievance Form: Instructions; Form
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Release-of-information forms
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Multisystemic Therapy (MST)
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Referral screening form: Word document
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Children's Home and Community-Based Treatment (HCT)
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HCT referral form: PDF document
For Maine DHHS referrals only:
Consider entering your referral directly online in our secure Access entry system. For more information about this confidential site and to register, please contact Amanda Fitts at afitts@kbhmaine.org.
Consider entering your referral directly online in our secure Access entry system. For more information about this confidential site and to register, please contact Amanda Fitts at afitts@kbhmaine.org.
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DHHS Office of Child and Family Services referral checklist: Word document
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Orientation manual: pdf document
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Orientation intake consent for treatment: Word document
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HIPAA consent for purposes of treatment, payment and operations: Word document
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Release-of-information forms
For Maine Dept. of Corrections referrals only:
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Department of Corrections (DOC) referral checklist: Word document
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Central access form: Word document
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Orientation manual: pdf document
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Orientation intake consent for treatment: Word document
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HIPAA consent for purposes of treatment, payment and operations: Word document
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Release-of-Information forms
Housing forms:
General-informational documents