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Heartland Regional Alcohol & Drug Assessment Center
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Consent and Release Forms

  • Assignment of Benefits Form
  • Adolescent Consent Form
  • Adolescent Consent Form - Spanish
  • Release of Information
  • Release of Information - Spanish
  • Release of Information - Medicaid
  • Release of Information - Medicaid - Spanish
  • Release of Information - Full System
  • Release of Information - Full System - Spanish
  • Release of Information - Criminal Justice
  • Release of Information - Criminal Justice - Spanish
 

Heartland Regional Alcohol & Drug Assessment Center
5500 Buena Vista • Roeland Park, KS 66205 • P.O. Box 1063 • Mission, KS 66222
Phone 913-789-0951 • Toll Free 1-800-281-0029 • Fax 913-789-0954
info@hradac.com