Artis Transitions

I'm READY

To Move Myself & My Family Forward

CONSENT

I understand that I give my permission for Artis Transitions to contact related health and wellness providers, law enforcement, legal services and state agencies to determine if I am a good fit for the Transitions Program based on information that I share with a Transitions Coach about my situation, needs and goals.

I understand that this online form will only begin the process of consent but I will have to sign it in person, as well, and discuss my situation with a Transition Coach before services will begin or before any provider or agency is contacted.

I understand that completing this form will not constitute legal advice, does not form a binding contract or relationship with Artis and I am not required to begin services with Artis Transitions, Inc.

I understand that in giving my authorization below, I am giving Artis Transitions permission to request information from the service provider(s) I have indicated, so that I can receive help with safety, health, psychosocial, and/or legal needs.

I understand that shared information will be treated with confidentiality and respect, and shared only as needed to provide the assistance I request.

I understand that releasing this information means that a person from the agency or service I have written below may request to talk to me.

At any point, I have the right to change my mind about sharing information between Artis, the designated agency or provider listed below and I can withdraw my consent in writing or by calling Artis Transtitions at any time.

Otherwise, this consent is good for one year from the date I sign it.

If I do not understand the information on this page, I understand it is my responsibility to contact Artis Transitions at 614-886-7439 or info@artistransitions.org to speak with a Transitions Coach who can explain this information to me before I make a decision to share my private information.

I understand that Artis Transitions will request sensitive, personal information on my behalf. I understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law.*

My Phone/Text Number*

Email*

Please List the Name, Phone Number, Location and or website of the Health Provider, Law Enforcement Agency, Social Services Agency, Behavioral Health Practitioner or Law Firm that you would like us to contact on your behalf. *

I'm Ready

PRIVACY POLICY

This Privacy Policy describes how we collect and use information about our online visitors. We know you care about your information and we want you to be fully informed about our practices.

This Policy may be changed or updated from time to time. By visiting Artis Transitions.org, you accept the practices described in this Policy.

When you use our website to make a financial contribution, register for a special event, sign up to volunteer or apply for a job we may ask you for your name, address, phone number(s), and other information relevant to the transaction. We will ask for standard credit card information when you make a financial donation, pay for an event, or make a purchase. This information is never shared with third-parties. We do not collect or save this information. We do not sell, trade, or share our donors’ personally identifiable information with any other entity.

We work with other companies to process credit card transactions and those companies also use encryption and other appropriate security measures.No website or electronic data can ever be completely secure, but we are always working to maintain up-to-date and appropriate security mechanisms.