Find a Form

CBA Clinical Forms 

Easily download our clinical forms below. 

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 Information 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