Form Center

Consumer Support Form– to be used for residents of Wicomico County that are active members in the Public Behavioral Health System (PBHS) and need assistance with mental health medications, mental health laboratory tests, and/or special needs such as security deposit, past due rent or utilities.

Individual’s Authorization Form – The Wicomico Behavioral Health Authority requires an Individual’s Authorization form to be completed for all agencies/businesses that we may need to contact to assist the consumer such as his/her mental health provider, landlord, pharmacy, and/or other agencies that will need proof of assistance.

Targeted Case Management Referral Form– to be completed to request Targeted Case Management services for residents of Wicomico County.

Residential Rehabilitation Services Application – to be completed by a mental health provider to request services.

Public Assistance to Adults Disability Certification Form – to be completed for all those being considered for the Residential Rehabilitation Program.

Homeless Identification and Birth Certificate Project – to be completed by a mental health provider or social service organization.

Youth Care Coordination Referral Form – to be completed to request Youth Care Coordination services for residents of Wicomico County.




Programs and Services

CONSUMER SUPPORT SERVICES Wicomico Behavioral Health Authority provides assistance to consumers of the public behavioral health system receiving behavioral health treatment and rehabilitation services within the fee for service network. This assistance is obtained via a “Consumer Support” Application. Request for pharmacy assistance, transportation to behavioral health-related appointments, laboratory costs as it relates to behavioral…

Go to Programs and Services →

Overview of the Public Mental Health System (PMHS)

Overview of the Public Mental Health System (PMHS) The PMHS is jointly coordinated and administered by the Mental Hygiene Administration (MHA), Core Service Agencies (CSA’s), and Value Options (the contracted Administrative Service Organization). MHA has oversight authority of the PMHS, which includes policy development, State-wide planning, resource allocation, and continuous quality improvement responsibilities. Value Options,…

Go to Overview of the Public Mental Health System (PMHS) →


View Full Site