Find a Form

CBA Clinical Forms 

Easily download our clinical forms below. Interested in completing these forms online? Visit our Form Resource Center.  

Online Form Resource Center

Looking for an administrative form? Log in to our provider portal for access to add a location, change of address and tax ID forms. 

Download the Form

Form Quicklinks 

• Discharge Form
• Peer Review Request
• Psychological Testing Preauthorization Form
• Authorization to Disclose PHI to a Third Party

Outpatient Mental Health Request Forms 

• Initial Outpatient Mental Health Treatment Request
• Continued Outpatient Mental Health Treatment Request
• Extended Outpatient Mental Health Treatment Request
• Outpatient Substance Use Disorder Treatment Request
• SCDMH Continued Outpatient Mental Health Treatment Request
• SCDMH Initial Outpatient Mental Health Treatment Request

Facility Forms 

• Facility-Based Treatment Form

Electroconvulsive Therapy Request Forms

• ECT Continuation Request
• ECT Initiation Request

Sending Forms to CBA

Fax: 803-714-6456
Phone: 800-868-1032
Mail to: 
Companion Benefit Alternatives, Inc. 
P.O. Box 10018, AX-315
Columbia, SC 29202