INTAKE FORMS

For Your Convenience

Here are the forms that you will need to
complete prior to your first appointment.

Follow these simple steps:

1. Select the appropriate form below and click on it.
2. Click "Printer" icon on the tool bar at top of the page,
      then press "OK" to print out your form.      
3. Read the general information provided.
4. Fill out the form.
5. Bring completed form to first appointment.

Start Here :
Choose A. or B.

A. CHD Intake Form (Adult)

B. CHD Intake Form (Child or Adolescent)

United Behavioral Health members:
You must also complete one of the forms below.

C. UBH Assessment Form (Adult)

D. UBH Assessment Form (Child or Adolescent)