Forms
If you are going to attend your first appointment at BHSI, you can print these forms ahead of time and complete them at home.
General forms
Adolescent Intake Forms
Child Intake Forms
- BHSI Client Rights and Responsibilities
- Authorization to Release Information
- BHSI Statement of Privacy Practices
- Treatment Agreement
- Tips on Refilling Your Prescriptions
- Adult Re-Open Form (use this instead of the Adult Intake Form if you have been to BHSI in the past)
- Adult Intake form
- Insurance form
- Primary Care release of information
- Medica Wellness Assessment ( If you have Medica Insurance)
Adolescent Intake Forms
- Adolescent Intake Form
- Insurance form
- Primary Care release of information
- Medica Wellness Assessment (If you have Medica Insurance)
Child Intake Forms
- Child Intake Form
- Insurance form
- Primary Care release of information
- Medica Wellness Assessment (If you have Medica Insurance)
