LifeBack - Get Yours

Our Services

Health Forms & Links

General Links

Annual Facesheet
Treatment Plan Signature
Treatment Effectiveness Screening Tool (Scheduled Forms)
Safety Plan/Contract
Suboxone Treatment Compliance (Outside Therapist Verification)
Upload and Sign A Document
Primary Care Release NJ
Primary Care Release PA
PA - MH Patient Bill of Rights
PA – SUD 255.5 Insurance Consent ROI
PA – SUD 255.5 Lab Screen Consent ROI – Lab Corp
PA – SUD 255.5 Lab Screen Consent ROI – QUEST

General Documents

Mental Health Advanced Directives For Pennsylvanians
Mental Health Pt Rights and Grievance 2019
Rapid HIV Testing Sites in Mercer County
PA Psych Advance Directives
Summer Heat and Sun Risks - Updated

Intake Links

Intake - Patient Rights
Intake NJ - MH Patient Rights and Grievance Information
Intake Form (Pre-Admit)
Intake - Treatment Effectiveness Screening Tool
Intake - Overall Health Wellness Questionnaire
Intake - Acknowledgement New Patient Information
Intake - Consent to Treatment
Intake - Financial Policy
Intake - HIPAA Notice of Privacy Practices/Receipt
PA - MH Patient Bill of Rights
NJ – Release of Information

For more information about LifeBack

(609) 482-3701

About Us
Contact Us
Crisis Information

LifeBack is state licensed and accredited Mental Health, Psychiatric, and Substance Recovery agency. Our dedicated team provides services to children, adolescents, and adults; utilizing a wide range of evidence based practices.

New Jersey

Pennsylvania