Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

You may download some DSHS forms. These are provided only if a DSHS program requests forms to be available electronically for public use. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. This means you can open, view, and print each form. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader.

We do our best to ensure the links below are accurate; but, if you find a link which does not work, please contact Forms and Records Management.

Number Form Name Form File
14-456 Physician Certification for Home Maintenance Allowance (HMA) (Home and Community Services)
13-021 Physical Evaluation
16-235 Photo Release
09-280B Petition for Modification - Administrative Order
10-629 Pet Record Review (Aging and Long-Term Support Administration)
17-337 Personal Service Request / Standard Referral (Developmental Disabilities Administration)
17-337 Personal Service Request / Standard Referral (Behavioral Health Administration)
11-154 Personal Pathway
17-180 Personal Information Release (Economic Services Administration)
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))