Apply For Services

If the application is for Residential Rehabilitation Services, please mail this form to:
Allegany County Mental Health System’s Office (CSA)
P.O. Box 1745
Cumberland, MD 21502
*Archway cannot modify this form, because it is issued by the state of Maryland.
The CSA office will then forward this form to Archway, if approved.

Additional forms:
Adult PRP Referral Form (Community Based Support Services) (Electronic Format)
Adult PRP Referral Form (Community Based Support Services) (Print Format)
CAYA (Child, Adolescent & Young Adult) Referral Form (Electronic Format)
CAYA (Child, Adolescent & Young Adult) Referral Form (Print Format)

​Mail these forms to:
Liz Wagoner
Intake & Referrals
45 Queen Street
Cumberland, MD 21502
301-777-1700 X 2112

Application

Rights and Responsibilities

Your rights

  • We will treat you with courtesy and respect, even when we’re working through a problem.
  • We’ll respect your culture and spiritual life.
  • We’ll give you information so that you can make informed decisions.
  • While we’re providing you services, there won’t be any mental, physical, verbal, or sexual abuse or neglect from staff. Staff won’t humiliate you.
  • Staff will not take advantage of you, especially when it comes to your money and things you own.
  • We don’t use any sort of chemical restraint. When providing mental health services, physical restraints are not used. When providing services funded by the Developmental Disabilities Administration, physical restraints are used only when pre-approved as part of the person’s behavioral plan.
  • We will protect your privacy. Your records are protected and aren’t available to staff who don’t need to see them.
  • You can see your Archway records by asking to do so. We’ll respond quickly.
  • We share information about you only with your permission.
  • You have the right to develop your Individual Plan, as well as the right to have other people help you write it.
  • We will do our best to resolve any of your complaints quickly. No one will hold it against you if you complain.
  • We are respectful to both the person making the complaint and the person subject of the complaint. The agency is committed to a thorough and prompt investigation while confidentially protecting personal information of all parties involved.
  • We’ll let you know how to contact self-help and advocacy services.
  • We support your right to follow or not follow your treatment and health plans, including medications.

Your responsibilities

Our services are based on a partnership between you and the staff. We’ll work together to write a plan that will help you reach your goals and follow through with the action steps. Your responsibilities include:

  • Make choices that help you stay healthy & meet your goals.
  • Participate in activities that promote physical, emotional, and spiritual health.
  • Learn about your disability and treatment options.
  • Understand benefits, risks, and side effects of medication so you can make informed choices.
  • Apply for all eligible entitlement benefits.
  • Participate in mental health treatment.
  • Keep your appointments.
  • Honor Archway’s “Respecting Each Other” statement.
  • Pay your portion or copay for services (if required).
  • Respect Archway property as well as property of other services users.
  • Be cooperative during all phases of the complaint process in order to resolve the complaint in the manner that respects all parties involved.
  • Report suspected fraud and abuse.

We’ll review these rights and responsibilities when you start services and annually thereafter. If you ever need any of this information explained or if you feel your rights have been violated, contact Archway’s Compliance Officer at 301-777-1700, Ext 2125. You can also fill out a complaint. Forms are posted throughout agency buildings.

Click to view a printable PDF of Your Rights and Responsibilities

Revised 12/2020