Authorization for someone else to
bring the patient to the appointment
Policy Notice and Privacy Practices
Patient Privacy Directive
Authorization for us to release information/Records Request Form
Child Change of Insurance Form
Adult Change of Insurance Form
Coordination of Care
Accepting new commercial insurance for children. Now accepting commercial insurance for adults.
Authorization for us to RECEIVE information
Private Pay Agreement for Medicaid
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Change of Address Form
New Patient Registration Forms
Adult Medical History Form
Child Medical History Form
Bracken Psychiatric Services
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