Patient Forms

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Intake Forms & Helpful Information

GENERAL FORMS

Medical Records Request
Credit Card Authorization Form
Intake B. Patient Intake Form
Intake C. Intake Packet
Intake D. Insurance Provider Appeal Waiver
Intake E. Agreement Regarding Minors

(only to be completed if identified patient is younger than 18 years of age; must be signed by a parent/guardian)

NEW JERSEY OFFICE

NJ Release of Information
Advanced Directive Information
Summer Heat and Sun Risks with Psychotropic Medications
Insurance Provider Appeal Waiver

PENNSYLVANIA OFFICE

PA Mental Health Program - Release of Information
Non-Discrimination In Services Policy
Insurance Provider Appeal Waiver

HOLIDAY HOURS

Christmas Eve (12/24): Closing at 1:00 PM
Christmas Day (12/25): Closed
New Year’s Eve (12/31): Closing at 3:00 PM
New Year’s Day (1/1): Closed

Questions:

If you are unsure if your appointment falls on these dates,
please ask the front office or call 609-482-3701.

Medication Management

Please plan ahead and call the office prior to
needing a refill to ensure it is completed in a timely manner.

Prescription Refill Line:

609-482-3701 x19
NEW GROUPS at

LifeBack!

learn more about the current groups
Start your day or take a lunch break with us —
8 AM and lunchtime appointments available!