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Client Forms for Phoenix Behavioral Health Services, LLC


To make an appointment, call us at 920-657-1780 or fill out and submit our Contact Us form.

Please print and fill out the following forms to bring along on your first visit to our office. Also, remember to bring a picture ID and insurance card(s).

All forms are Adobe PDF files. If you have trouble viewing the forms you need, you may need to download and install the free Adobe Reader application.


New Patient Forms (Adult)

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  • New Client Clinic Policies & Procedures (Welcome Letter)
  • Health Insurance Portability and Accountability Act (HIPPA) Form
  • Payment and Credit Policy/Patient
  • New Client Information Form (Demographic page)
  • Telemedicine Informed Consent Form
  • In-Person Informed Consent Form
  • Payment and Credit Policy/Patient
  • Client Informed Consent & Acknowledgement of Program
  • Medical History
  • Client Intake and Assessment
  • BDI – Beck’s Depression Inventory

New Patient Forms (Child)

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  • New Client Clinic Policies & Procedures (Welcome Letter)
  • Health Insurance Portability and Accountability Act (HIPPA) Form
  • Payment and Credit Policy/Patient
  • New Client Information Form (Demographic page)
  • Telemedicine Informed Consent Form
  • In-Person Informed Consent Form
  • Payment and Credit Policy/Patient
  • Client Informed Consent & Acknowledgement of Program
  • Medical History
  • Child Intake and Assessment

We are here to help, contact us for an appointment.