LifeBack - Get Yours

Records Request

To perform a medical records request, please download and complete the forms below in order for us to release your information or medical records.

You may fax a records request to 609-482-3702 or drop them off at the front desk.

Consent For Release
Record Request
Medical Records Request Form

For more information about LifeBack

(609) 482-3701

About Us
Contact Us
Crisis Information

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

New Jersey

Pennsylvania