Behavioral Health/Support Services Online Forms

– Online Behavioral Health Intake Form

– Online Prescription Management Agreement for ADHD Medications

– Student Behavioral Health Initial Assessment Form

– Student Behavioral Health Follow-Up Assessment Form

– Child Behavioral Initial Assessment Form

– Child Behavioral Follow-Up Assessment Form

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Southeast Mississippi Rural Health Initiative, Inc.
This health center receives HHS funding and has Federal Public Health Service (PHS) FTCA deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a FTCA deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
© 2026 Southeast Mississippi Rural Health Initiative, Inc. All rights reserved.

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