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Lapeer County Community mental Health

Agency Phone Number: (810) 667-0500
Customer Service and Access Center: (888) 225-4447

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Intake Packet

intake packet

Intake packet forms should be completed for the initial visit.  If you need assistance completing the forms, the intake worker will provide assistance at the initial appointment.  If you have questions about the forms, please call 810-667-0500 between 8:00 a.m. and 5:00 p.m.

Forms to Complete before your Appointment

Adult Personal Information Form (for people seeking services age 18 and over)

Adult Insurance Form (age 18 and over)

Child/Adolescent Information Form (for people seeking services age 0-17)

Child/Adolescent Information Update Form (for people seeking services age 0-17 and re-entering services within the last 6 months)

Child Insurance Information Form (age 0-17)

 

 

  • CMH and You
    • How to make an appointment/eligibility
    • Recipient Rights
    • Corporate Compliance
    • Customer Services
    • Customer Handbook
    • Provider Directory
    • Medicaid Provider Manual
    • Affordable Health Insurance
    • Community Electronic Health Records (CEHR)
    • Intake Packet
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Lapeer County Community mental Health

Lapeer County Community Mental Health 1570 Suncrest Drive Lapeer, MI 48446 810-667-0500
  • Region 10 PIHP
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