New Patient Handouts:


The following handouts are for your review. Please read these BEFORE completing the New Patient Forms.

  1. Welcome Letter(.PDF)
  2. New Patient Handout(.PDF)
  3. HIPAA Notice of Privacy Practices (.PDF)
  4. Know Your Rights Brochure(.PDF)
  5. Communicable Disease Brochure(.PDF)
  6. Advanced Directives Brochure(.PDF)
  7. Medicaid Fair Hearing Brochure(.PDF)
By completing the following New Patient Forms, you are agreeing that you have read and understand the New Patient Handouts listed above.
IMPORTANT: All appropriate forms must be completed in their entirety and emailed to medicalrecords@recoverypathwaysllc.com with your name and appointment date in the subject line.
You may also fax these forms to:
Essexville - 989-391-9596
Corunna -  989-494-0405
Missing information or incomplete forms could result in your appointment being rescheduled.
If you have questions on any of these forms, please contact the office.

Substance Use Disorder Patient Forms


  1. Adult Intake  (.PDF)
  2. Patient Demographics(.PDF)
  3. Biopsychosocial History Form(.PDF)
  4. Informed Consent(.PDF)
  5. Notice of Privacy Practices(.PDF)
  6. Limited Authorization to Exchange Information with your Primary Care Provider(.PDF)
  7. Limited Patient Authorization to Disclose/Obtain Protected Health Information:( .PDF )
  8. Substance Use Disorder Treatment Agreement(.PDF)
  9. Drug Testing and Pharmacy Consents(.PDF)
  10. DAST/Depression/Anxiety Screening Tools(.PDF)
  11. Sucide/MAST Screening Tools(.PDF)
  12. FASD/Communicable Disease Screening Tools(.PDF)
  13. Nutrition Risk Assessment Screening Tool(.PDF)
  14. Opioid Risk Tool(.PDF)
  15. ACE Questionnaire(.PDF)

New Mental Health Patient - Adult


  1. Adult Intake  (.PDF)
  2. Patient Demographics(.PDF)
  3. Informed Consent(.PDF)
  4. Notice of Privacy Practices(.PDF)
  5. Limited Authorization to Exchange Information with your Primary Care Provider(.PDF)
  6. Limited Patient Authorization to Disclose/Obtain Protected Health Information:( .PDF )

New Mental Health Patient - Minor


  1. Patient Demographics(.PDF)
  2. Parent Questionaire (.PDF)
  3. Informed Consent(.PDF)
  4. Consent to Treat Minor Form (.PDF)
  5. Notice of Privacy Practices(.PDF)
  6. Limited Authorization to Exchange Information with your Primary Care Provider(.PDF)
  7. Limited Patient Authorization to Disclose/Obtain Protected Health Information:( .PDF )

Sliding Fee Scale:


Application_for_Sliding_Fee_Discount_Program:(.PDF)

Please fill out the form COMPLETELY and return with PROOF OF INCOME in one of the following ways:

  1. Email to MedicalRecords@Recoverypathwaysllc.com
  2. Fax to 989-391-9596
  3. Mail to 863 N. Pine Road Suite A Essexville, MI 48732
If you do not include proof of income, the application will not be processed. If you have any questions, please contact the office at 989-928-3566.