Adults:
SS77
Adult Background
Intake Form
HIPAA
Information & Treatment Agreement
Patient Care Communication
Coordination of Benefits
Health Insurance Claim
Health Policy Notice
Adolescents (13-18):
Adult Background
Intake Form
HIPAA
Information & Treatment Agreement
Patient Care Communication
Coordination of Benefits
Health Insurance Claim
Health Policy Notice
Adolescent History (Adolescent should fill out)
Child Treatment Consent
Child Problem Questionnaire (Adolescent should fill out)
ADHD Questionairre
Family Questionairre
Intake Form
HIPAA
Information & Treatment Agreement
Patient Care Communication
Coordination of Benefits
Health Insurance Claim
Health Policy Notice
UBH/UHC Clients:
Child Treatment Consent
Child Problem Questionnaire (Adolescent should fill out)
ADHD Questionairre
Family Questionairre
Intake Form
HIPAA
Information & Treatment Agreement
Patient Care Communication
Coordination of Benefits
Health Insurance Claim
Health Policy Notice