Forms & Resources

Forms

FROM: Authorization & Consent for Release of Information

TO: Authorization & Consent for Release of Information

AMF Consent for Compliance Report

AMF Quarterly-Reports

AMF Monthly Meeting Log

AMF Medication Log

AMF Outreach

Arkansas Healthcare Professionals Screening Program

  • The Arkansas Professionals Screening Questionnaire is available at no cost to licensed healthcare professionals or healthcare professionals training in Arkansas. The first step is a voluntary and completely anonymous questionnaire designed to help you assess your current state of mental health and well-being.

AMF Resources

AR Impaired Physician & Dentist Treatment Act

Participant Handbook 

Alcoholics Anonymous

Sexaholics Anonymous

Sex Addicts Anonymous

Arkansas Regional Committee of Narcotics Anonymous

Recovery Traps 1

Recovery Traps 2

CBD Statement

  • AMF Statement regarding CBD use:
    • If testing is positive for THC we will handle it as we would any positive screen. This would mean up to and including obtaining a new comprehensive evaluation.

COVID-19 Updated statement and information

2023 Distressed Physician Courses by Professional Renewal Center

Integrating Confidential Mental Health Care to Support Physician

The Whole Physician: Physicians with Substance Use Disorder: Help is Available 

National Resources

The Federation of State Physician Health Organizations

The Substance Abuse and Mental Health Services Administration

The National Institute on Drug Abuse

The National Institute on Alcohol Abuse & Alcoholism

The American Society for Addiction Medicine

Evaluation & Treatment Centers

730 New Hampshire, Suite 222
Lawrence, KS 66044
Phone: 785.856.0473
Fax: 785.841.8781

BRADFORD HEALTH SERVICES
1189 Albritton Rd
Warrior, AL 35180
Toll Free: 800.333.1865

CARON
243 Galen Hall Road
Wernersville, PA 19565
Phone: 1-800-854-6023

CENTER FOR PROFESSIONAL EXCELLENCE (CPE)
624 Grassmere Park Drive, Ste 11
Nashville, TN 37211
Toll Free: 877.861 .1170
Fax: 615.838.0728

THE GABBARD CENTER
6750 West Loop South, Suite 460
Bellaire, TX 77401
Phone: 713.665.1600

MARR, INC.
2815 Clearview Place
Doraville, GA 30340
Phone: 678.805.5125

THE MENNINGER CLINIC
12301 Main Street
Houston, TX 77035
Phone: 800.351.9058
Fax: 713.275.5000

PALMETTO ADDICTION RECOVERY CENTER
86 Palmetto Road
Palmetto, LA 71269
Toll Free: 800.203.6612

PAVILLON
241 Pavillon Place
Mill Spring, NC 28756
Toll Free: 800.392.4808

PINE GROVE
2255 Broadway Drive
Hattiesburg, MS 39402
Toll Free: 888.574.4673

PROFESSIONAL RENEWAL CENTER (PRC)
1201 Wakurusa Suite E-200
Lawrence, KS 66049
Toll Free: 877.978.4772
Fax: 785.842.5231

RIVERMEND HEALTH INSTITUTE (POSITIVE SOBRIETY)
680 N. Lake Shore Dr.
Chicago, IL 60611
Phone: 1.844.526.6310

SANTE
914 Country Club Road
Argyle, TX 76226
Toll Free: 800.258.4250

SUNSPIRE HEALTH
3800 County Road 444
Princeton, TX 75407
Phone: 1.877.200.4357

TALBOTT RECOVERY CAMPUS (TRC)
5448 Yorktowne Drive
Atlanta, GA 30349
Toll Free: 800.445.4232
Fax: 770.994.2024

UF HEALTH-FLORIDA RECOVERY CENTER
4001 SW 13th Street
Gainesville, FL 32608
Phone: 1.352.265.5525

VANDERBILT COMPREHENSIVE ASSESSMENT PROGRAM (VCAP)
1601 23rd Avenue South
Nashville, TN 27212
Phone: 615.322.4567
Fax: 615.322.7526

Seek Confidential Help

Contact us if you have been board-ordered or are volunteering to participate in the physician health program.

Hours
Mon – Thurs: 8:30 a.m. – 4:30 p.m.
Fri: 8:30 a.m. – 12 p.m.

HPSP – Suicide Prevention / Stress & Anxiety Questionnaire