Forms for Providers

Providers Forms Image

To file a complaint about a provider or BHSB, please click on Complaint Form. Learn more about our complaint process here

To report a critical incident please complete the Critical Incident Form and email the completed form to

For more information about the complaint process contact Diana Long, Incident Management & Investigations Manager at

Because each funding opportunity may call for different forms, be sure to check the Word document attached to ensure that the required forms are submitted. Please see individual description for the correct person to contact with questions or concerns.

Contract Attachments

Critical Incident Form

Outcome Reporting Forms

If you have any questions related to the data reporting forms, please call 443-615-7806.