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(609) 482-3701
(609) 482-3701
info@lifebacknj.com
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For Patients
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Menu
About Us
Meet the Team
Leadership
Prescribers
Clinicians
Billing
Intake
Reception
Services
Mental Health and Wellness
Psychiatric Treatment
Children and Adolescents
Family Therapy
Couples Counseling
For Patients
Intake Process
Patient Forms
Prescription Refills
Resources
Articles
Join Our Team
FAQs
Contact Us
Patient Survey
Patient Forms
Intake Forms & Helpful Information
GENERAL FORMS
Intake Documents
Overall Health Wellness Questionnaire
Acknowledgement of New Patient Information
Consent to Treatment
Financial Policy
HIPAA Notice of Privacy Practices/Receipt and Acknowledgment
Medical Records Request
Patient Rights
NEW JERSEY OFFICE
NJ Mental Health Patient Rights and Grievances
NJ Release of Information
PENNSYLVANIA OFFICE
PA Mental Health Bill of Rights
PA Mental Health Program - Release of Information
PA Substance Use Program Release of Info - Insurance Consent
PA Substance Use Program Release of Information - Lab Screen
PA Substance Use Program Release of Information