Additional Resources

Sample TMH Program Documents

Directors or clinicians seeking support on developing essential forms to begin telemental health services may find it helpful to review the following sample program documents. All documents were generously shared by CACs who provide telemental health services.

Montana Rural Telemental Health Program Documents

The Children’s Alliance of Montana has developed several very helpful documents to support delivery of TMH services through their statewide telemental health network.

Click here to view and download the following documents via Google Drive:

  • Program Info Sheet for Therapists
  • Program Info Sheet for Caregivers
  • Referrer Handbook
  • Therapist Handbook
  • Child Referral Form
  • iPad Request Form
  • Telemental Health Box Request Form

Visit the Montana Rural Telemental Health Program webpage to learn more.

Dakota Children’s Advocacy Center – Forms for Initiating TMH Services

The Dakota Children’s Advocacy Center has generously shared several of the forms they require clients to complete prior to participating in telemental health services:

Ed and Nancy Hanenburg Children’s Advocacy Center – Telehealth Services Informed Consent

The Ed and Nancy Hanenburg CAC has shared their recently updated Telehealth Services Informed Consent form

TMH Policies and Procedures

As with any sample policies, we encourage use of these documents as guidance only and for each CAC or Chapter to consider creating their own documents that reflect the needs and services provided for their own clients.

Page Last Updated: June 2024

Take a Deeper Dive

For additional CAC-focused resources to support in implementing a TMH program, refer to WRCAC’s Telemental Health Network Implementation Resource Toolkit.

Request Technical Assistance

Interested in further guidance or additional resources on this topic? Submit a request for TA and a member of our team will get in touch to provide customized support.

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