FORMS

Purple wildflowers among green foliage in a garden.
Purple wildflowers among green foliage in a garden.


Providers who wish to refer a client for psychological testing can complete our Psychological Assessment Referral Form. Once completed, please fax it to 907-308-4022.

Referring a Client for Psychological Testing

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    How to Access Your Records

    At Silver Fern Behavioral Health, your privacy and access to your information are important to us. This guide explains how to request your records, what types of documentation are available, and how we protect your confidentiality. Please review the following instructions carefully, and don’t hesitate to reach out with any questions.

    Note: A signed Release of Information (ROI) form is required for all record requests, including those made by you for personal use.

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    Revocation of Release of Information Through Portal

    If you previously authorized Silver Fern Behavioral Health to share your protected health information with another person or organization, you have the right to revoke that permission at any time. This form allows you to formally withdraw a prior Release of Information (ROI).To complete the revocation, fill out the form in your client portal and submit it electronically.

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    Releases of Information Through Portal

    If you need to authorize the release of information to another provider, school, or individual, you can complete a Release of Information (ROI) form securely through the client portal.

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    General ROI Form

    If you prefer to complete a Release of Information form outside the portal, you may download a blank copy here. Use this to authorize communication with therapists, specialists, or other third parties involved in your care. Return completed forms securely via the SimplePractice client portal or upload it as a document in your portal account.

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    Primary Care Provider (PCP) ROI Form

    If you'd like your provider at Silver Fern Behavioral Health to coordinate care with your Primary Care Provider, please complete this form. After completion, return it through your client portal to keep your care team informed and connected.

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    Emergency Contact ROI Form

    To ensure continuity of care in a crisis, you may authorize Silver Fern Behavioral Health to communicate with a trusted emergency contact. Once filled out, please return the completed form through the secure SimplePractice portal or upload it directly under your “Documents” section.