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CRISIS 1-800-567-4673
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  • SERVICES
    • Assessment
    • Community Psychiatric Support Services
    • Counseling
    • Crisis Intervention
    • Drug Free Workplace Training and Support
    • Drug Screenings
    • Employee Assistance Programs
    • Gambling Addiction Therapy
    • Law Enforcement & Behavioral Health
    • Mental Health First Aid
    • Prevention Education
    • Psychiatric Services
    • Psychological Evaluation
    • Putnam Adolescent Response Team for Youth
    • Socialization and Skill Building Group
    • Substance Use
    • Trauma-Focused Cognitive Behavioral Therapy
    • WRAP Around Services
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Forms

FormsBIMC_admin2025-02-26T11:01:08-05:00

STEP 1

STEP 1

Please print, fill out, and bring these forms with you on your first visit:

Intake Demographic Form

PHQ-9 and PHQ-A

OUTCOME (Adult & Child)

Confidentiality, Disclosure and Billing

TeleHealth Consent

New Client Survey (Optional)

STEP 2

Please read the following information:

Welcome Letter

HIPAA-Notice-of-Privacy-Practices

Client Rights

Client Grievance Procedure

Client Code of Conduct

Transmission of and Exposure to HIV, Hepatitus and Tuberculosis

Pathways is licensed by the Ohio Department of Mental Health and Addiction Services and nationally accredited through CARF.

CONTACT INFORMATION

  • 835 North Locust Street, Ottawa, Ohio 45875
  • 419-523-4300
  • CRISIS 1-800-567-HOPE (4673)
  • 1-877-880-4300 | Toll Free
  • 1-800-468-4357 | Toll Free – Emergency 24/7
  • 419-523-6188 | Fax

HOURS OF OPERATION

  • Monday thru Thursday 7:00am - 7:00pm
  • Friday 8:00am - 12:00pm
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