Forms & Documents > Client Application_Intake Forms > BH Shared Intake Forms

Name Description Type Action
Acknowledgement-of-Notice-of-Privacy-Practices English_2-27-18 Acknowledgement of Notice of Privacy Practices File Download
Application-for-Services_English_11-30-12 Application for Services File Download
Consent-for-Treatment English_v6_2-26-18 Consent for Treatment File Download
Consent-for-Treatment Spanish_2-27-18 Consentimiento para Tratamiento File Download
Acknowledgement-of-Notice-of-Privacy-Practices Spanish_2-27-18 Reconocimiento de Noticia de Practicas Privadas File Download
Application-for-Services Spanish_11-30-12 Solicitud de servicios File Download
Health-Questionnaire English-2014 Health Questionnaire File Download
Health-Questionnaire Spanish_12-14 Cuestionario de salud File Download
Notice-of-Privacy-Practices_English_5-2017 Notice of Privacy Practices File Download
Notice-of-Privacy-Practices_Spanish_5-2017 Aviso de Practicas de Privacidad File Download

Please contact our access line at 1 (800) 838-1381 for information or to schedule an appointment. All services are available in Spanish.