Forms

 Signed applications can be submitted via mail, fax (208-332-7559) or email to cvcp.admin@iic.idaho.gov.

Provider Forms

Initial Treatment Plan

• Chiropractic, Massage, Physical Therapy
• Medication Management

Mental Health Claim Forms

• Mental Health Treatment Plan(PDF)
• Mental Health Progress Report (PDF) 
• Family Assistance Treatment Plan (PDF)