TM
Forms & Authorizations
Complete Availia's required forms directly from any device.
Select the form you need from the sections below.
Telehealth
Forms
Complete before your first telehealth session; it covers the technology used, privacy considerations, and your rights as a telehealth client.
Required for all telehealth clients. Provides your location and emergency contact information so we can respond appropriately if needed during a session.
ROIs
(Release of Information Authorizations)
Authorize Availia to share or receive your information with a person or agency of your choosing. Complete one form per recipient.
Authorize your urinalysis results to be released directly to Availia from Drugscan, Absolute Drug Testing, or both. Complete before your same-day urinalysis appointment.
Administrative Forms
Required for all clients before services begin. Covers service types, confidentiality, terms, your rights, & your responsibilities.
Required by Washington State law before services begin. Includes your provider's credentials, experience, & approach.
Describes your right to file a complaint internally with Availia or externally, and with whom. Acknowledge here.
Apply for a reduced-fee rate. Supporting documentation is required. Eligibility is determined by 200% Federal Poverty Level.
DOT SAP Forms
Complete before your DOT SAP evaluation. Provides Availia with the information needed to begin the SAP process including employer, incident, & DER details.
Required before your DOT SAP evaluation. Covers the role of the SAP, confidentiality limits, your rights under 49 CFR Part 40, & the fee schedule for SAP services.
