Below are downloadable forms for providers and patients, including Release of Information (ROI) forms, referral forms and what to expect/information guides for inpatient and outpatient services:

Referral For Mental Health Services Form (Inpatient)
Release Of Information Form (Inpatient)
What To Expect/Info Guide (Inpatient Hospitalization)
Referral For Mental Health Services Form (Outpatient)
Release Of Information Form (Outpatient)
What To Expect/Info Guide (Outpatient Programs)

Are you or someone you love experiencing emotional, behavioral or substance abuse problems? Emerald Coast Behavioral Hospital offers no-charge assessments to help you determine what is needed and what the next steps should be.

Never lose hope. Help is just a phone call away, and we are available 24 hours a day, 7 days a week. Call Emerald Coast Behavioral Hospital at 850-763-0017 for more information, to schedule an appointment or for emergency mental health services and evaluations.

You will have an initial evaluation with one of our counselors, and if hospitalization is indicated, we will gladly answer any questions that you may have. If you are admitted, you will be asked to authorize a release of information to the therapist or doctor who may have referred you or to your employee assistance counselor or school. You don’t have to authorize any of these, but we recommend that you do since these professionals will play an important role in planning for discharge.

Download a Release of Information (ROI) Form

The sensitive nature of personal and family problems demands protection of patient confidentiality; therefore, only the people you authorize will know about your hospitalization, and these people will receive only the information that is necessary for them to continue your care or give you support once you are discharged.

It is important to remember that many people experience mental illness. In fact, mental illness is the most prevalent disease in America – more prevalent than cancer, heart and lung disease combined.

• One in four Americans will suffer from a mental illness or substance abuse disorder at some time in their lives
• One half of all chronic mental illness begins by age 14; three-quarters of all chronic mental illness begins by age 24
• Approximately 16 million adults in America live with major depression
• Approximately 2.4 million adults in America live with schizophrenia
• Suicide is the 10th leading cause of death in the U.S. and an overwhelming majority of suicide victims are found to have a diagnosable mental disorder
• Approximately 50% of youths (ages 8 to 15) with mental illness received no mental health services in the previous year
• Approximately 60% of adults with mental illness received no mental health services in the previous year

It’s comforting to know that many people have problems similar to yours. And, it’s also comforting to know that there is a place you can come for support, guidance and professional treatment. You are not alone–Emerald Coast Behavioral Hospital is here to help. If you or a loved one is struggling with mental illness and/or addiction, call us for additional information or to schedule a confidential assessment. Never lose hope.