Reparations Provider Forms

Mental Health Treatment Plans

Mental Health Treatment Plan for Adults (.pdf)

Mental Health Treatment Plan for Adults (.docx)

Mental Health Treatment Plan for Minors (.pdf)

Mental Health Treatment Plan for Minors (.docx)

Mental Health Provider Statement (.pdf)

Mental Health Provider Statement (.docx)

Common Billing Forms

CMS-1500 Billing Form

UB-04 Billing Form

ADA Dental Claim Form

Fast Track Reimbursement Form - Code R

W9 (UOVC Just needs the first page complete)