NAMI Santa Cruz County
Help Line: (831) 427-8020
Línea de ayuda en español: (831) 205-7074
Administrative Office: (831) 824-0406
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For more mental health crisis resources, CLICK HERE

Family Information Form

Fill out this Family Information Form to provide information to your loved one's mental health providers (therapist, psychiatrist, case manager), law enforcement, and/or hospital staff. Use clear, concise, short, fact-based details. ​This can be used even without an authorization to release confidential information from your loved one. 
family_information_form.pdf
File Size: 765 kb
File Type: pdf
Download File

Release of Confidential Information

HIPPA requirements prevent staff from giving you any information without a Release Form signed by client. This Release of Information form will allow your loved one to authorize hospital staff and mental health providers to speak with you. They may have to sign another one when at the facility.
release_of_confidential_information.pdf
File Size: 134 kb
File Type: pdf
Download File

info@namiscc.org  • Help Line (831) 427-8020 • Office Line (831) 824-0406 • NAMI SCC, 542 Ocean St, Suite F, Santa Cruz , CA 95060
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  • Mental Health Client Action Network (MHCAN)
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NAMI Santa Cruz County is a 501(c)(3) nonprofit Donations are tax-deductible
Federal Tax ID # 77-0002878
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The information available on and through the namiscc.org website is presented in summary form as a supplement to, and NOT a substitute for, the knowledge, skill, and judgment of qualified psychiatrists, psychologists, physicians and health care professionals. The information on NAMISCC.org has been obtained from sources believed to be accurate and reliable. However, NAMI makes no warranty as to the accuracy, reliability or completeness of this information. We have NOT vetted the Providers.  

Information accessed on and through NAMISCC.org is provided "AS IS" and without warranty, express or implied, including, but not limited to, any implied warranty of merchantability or of fitness for a particular purpose.