Our agency buildings will not be open on Thursday 2/3 or Friday 2/4. All scheduled appointments will be switched to telehealth. Clients will be notified via phone.

 

Forms

Primary Care

Youth Care

Adult Care


Employee Assistance Program (EAP)

Substance Use Treatment

forms

Welcome!
We are here to help with Mental Health, Physical Health and Substance Use Care.

Please bring these items when you come in:
– Proof of Income
– Proof of Residence
– Proof of Insurance
– Proof of Custody (if applicable)

First visit may take approximately 3-4 hours to ensure we serve you well.
Walk-in, 8 AM to 12 PM, Monday through Friday

Using library below, print out intake forms and bring with you when you come in.

Mental Health Services

pdf
Client Registration Form
pdf
Diagnostic Assessment Questionnaire
pdf
Health History Form
pdf
Modified Simple Screening Instrument and Tool

Insurances Accepted: Must bring at time of visit

  • Anthem
  • CareSource
  • Molina
  • United Health Care (Choice Plus)
  • Buckeye
  • Medicare A & B
  • UHC Community
  • UMR

*In March 2020, the Ohio Department of Medicaid (ODM) made a number of operational changes to its Medicaid program in response to the COVID-19 public health emergency (PHE).
Please click here for key information and to update your information.

Primary Care Services

pdf
Primary Care Intake Form (Required)

Insurances Accepted: Must bring at time of visit

  • Aetna
  • Anthem
  • Ambetter
  • Buckeye Medicaid
  • Caresource
  • Cigna
  • Humana – some plans (no Medicare Gold Plan)
  • Medicaid
  • Medicare Part B
  • Molina
  • United Healthcare Community plan
    – Commercial and Medicare
  • Wellcare by Allwell

Click on desired file to print and keep for your records.

pdf
Client Rights Brochure
pdf
Notice of Privacy Practices
pdf
Grievance Procedures
pdf
Request for PHI (Protected Health Information)
 

We are committed to providing the best care to the persons we serve. Please share suggestions that would improve your experience working with South Community.

To Whom It May Concern:
I am a parent of a child with special needs. We have been involved with South Community for many years. It is a partnership that I have come to rely on as an integral part of my son’s support system.

The summer program that South Community has in place is an awesome program that provides a wonderful opportunity for many kids at risk, who otherwise would be left out of a truly adventurous experience. READ MORE >>

I honestly do not know what I would have done without South Community. It has helped me so much in rebuilding my life. I went from living at home with my mother for financial reasons, and also severe depression, to having a place of my own and a job!

Thanks to South Community, I was able to get the therapy I needed. I was also able to obtain a caseworker, Lynn Wynstrep. Lynn helped me get my life back in order. READ MORE >>

To Staff of South Community:
Thank you all for a wonderful training year. You guys were a great supportive staff to work with. I felt like I was part of the team here, and I appreciate everyone for helping me with anything I needed throughout the year.

I know that many agencies talk about having a recovery focus, but the staff here truly implements it. I noticed it and my clients noticed it. From the front service desk to the providers in the back, there is an emphasis on client care. READ MORE >>

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