Patient Submission Forms

This page is for current patients to submit required forms. Please find the appropriate form below and submit it as needed.

For any concerns or questions, contact: ben@granitemountainbhc.com

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I. BHRF/IOP Member Forms:

1. Weekly and Case Management Forms – IOP

• • Member Weekly Work Schedule Submission – Due every Sunday before the next work week.
  • Case Management Request Form – For requesting case management processes.
  • Patient Pass Request Form – Request events, funds, or other approvals.

2. Medical and Medication Forms – IOP

• • Medical Appointment Request Form – Request a medical appointment.
  • Medication Refill Request Form – Securely request a medication refill. Please allow time for processing.

3. Feedback & Concerns – BHRF & IOP

• • C.A.R.E. Member Grievance Form – Submit concerns, feedback, or appreciation regarding care, staff, or facility conditions.
  • Patient Completion Satisfaction Survey – Provide feedback after completing BHRF or IOP programs.

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 II. OP Sober Living Forms (formerly “Alumni Forms”)

• Overnight Pass Request – For OP Sober Living members only – OP (Not IOP)
• OP Sober Living Fees Form – For sober living fee submissions. OP/IOP

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III. Rules & Regulations to Remember:

 

Residential & Transitional Program Policies:

• • Community Phone Policy (Residential) After 6 PM:
    • Monday & Thursday – 105
    • Tuesday & Friday – 104
    • Wednesday & Saturday – 103
  • Transitional Program (IOP) Phone Use: See a BHT for guidance (Varies by house).
  • No cell phone use at Residential unless approved by management or for case management purposes.
  • No visitation during the Residential program.
  • Transitional program visitations: Only allowed via pass request for children under 13.

This will be updated soon with more information regarding policy and rules.