New Patient Registration Forms

Welcome to Restore Behavioral Health!   Please complete the new patient forms below prior to your Intake appointment.

 

  1. NEW PATIENT REGISTRATION FORM:https://hipaa.jotform.com/200924482569159
<script type="text/javascript" src="https://form.jotform.com/jsform/200924482569159"></script> 2.    PSYCHOLOGICAL SERVICES INFORMED CONSENT <script type="text/javascript" src="https://hipaa.jotform.com/jsform/200926272503045"></script>. 3.   RBH HIPAA NOTICE: <script type="text/javascript" src="https://hipaa.jotform.com/jsform/200926338859163"></script> 4.  RBH NON COURT-RELATED SERVICES CONSENT <script type="text/javascript" src="https://hipaa.jotform.com/jsform/200984280488060"></script> 5. RBH CONSENT FOR TREATMENT OF A MINOR: <script type="text/javascript" src="https://hipaa.jotform.com/jsform/200985420188054"></script> 6.  RBH MEDICATION LIST: <script type="text/javascript" src="https://hipaa.jotform.com/jsform/200985819388169"></script>