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Forms

Acknowledgement of Receipt (English and Spanish)

Advanced Directive (English and Spanish)

Change of Provider (English and Spanish)

Client Financial Review (English and Spanish)

Client Questionnaire (English and Spanish)

Consent Treatment of a Minor (English and Spanish)

Email and Text Consent (English & Spanish)

General Grievance Form (English)

General Grievance Form (Spanish)

Informed Consent (English and Spanish)

Member Services Guide (English and Spanish)

Notice of Privacy Practices (English and Spanish)

Primary Care Providers

Problem Resolution Guide (English and Spanish)

Release of Information From CCBH (English and Spanish)

Release of Information To CCBH (English and Spanish)

Youth Caregiver Affidavit (English)

Youth Caregiver Affidavit (Spanish)

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  1. Colusa County California

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  1. County of Colusa
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    Colusa, CA  95932
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