Behavioral Health Online Consents

In order to receive services, you must first be referred by a participating school counselor or primary care provider. Please speak with your child’s school counselor or primary care provider to determine if they are participating in this program. Prior to receiving services, a parent or guardian must complete and submit the appropriate forms below. Once the forms have been received by our team, you will be contacted to set up your child's appointment. If you have questions, please call 844-856-6926.

TCHATT Program Consent Forms

For families referred to TCHATT by their participating school counselor.

1. Informed Consent for Services Provided through the Texas Child Health Access Through Telemedicine (TCHATT Initiative): provides consent for the first intake screening, brief intervention services, one-time consultation with a TCHATT child psychiatrist and case management support with a licensed behavioral health clinician.

2. Demographics form: provides information to create the telebehavioral health medical record in Children’s Health electronic medical records.

3. Release of Information: provides consent to share behavioral health information with school personnel.

4. General Consents: provides consent for virtual and in-person services and acknowledgement of exchange of health information and financial responsibility for billed services.

TCHATT Program Consent Forms: English

Treatment Package

For families who will receive in-person or virtual health therapy services.

1. General Consents: provides consent for virtual and in-person services and acknowledgement of exchange of health information and financial responsibility for billed services.

2. Consent for Treatment: provides consent for individual or family therapy with a licensed behavioral health clinician

Treatment Package