Mental Health Provider

Mental health reporting forms

Mental health treatment request forms


Wraparound / Integrated Service Array forms - Updated January 2015


Attached are the forms that make up the new Multnomah HSO Wrap/ISA Referral packet.
Most are self explanatory and the checklist will guide you through the required forms for ISA or Wrap referrals. Please discard any old referral material for our program and use these going forward. Once completed and signed by the client/guardian the forms should be faxed to 503 988-3328. 

Please call our Intake staff at 503 988-4161 with any questions you might have about the forms or the process. Thank you for referring to our program and being a critical collaborating member of our Child and Youth System of Care. 


ICTS forms


Clinical guidelines

Multnomah Mental Health

State and Health Share / Multnomah Mental Health Contracts