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SHEALogo

Senior Health and Education Partners, PLLC

  • (office): (919) 457-1517

  • (Toll Free): (888) 663-8522

  • Home
  • Services
  • About
    • Partnership
    • Meet the Team
  • Mental Health Care Forms
  • Contact
  • Careers
  • SHAE Kudos
Cognitive Testing
Cognitive Testing
  • Home
  • Services
  • About
    • Partnership
    • Meet the Team
  • Mental Health Care Forms
  • Contact
  • Careers
  • SHAE Kudos

Mental Health Care Forms

Please click the link below to submit your new patient registration packet and/or individual forms online through a secure and HIPPA compliant server.

  • New Patient Registration, Patient Consent Agreement, Psychiatric History Questionnaire
  • Facility Partnership Agreement

You can also click the links below to download the PDF copy of our registration packet and/or forms to submit via fax to 919-363-7697

  • New Patient Registration, Patient Consent Agreement, Psychiatric History Questionnaire
  • Facility Partnership Agreement
  • Access to Protected Health Information Request Form

SHEALogo

(office): (919) 457-1517

(fax): (919) 363-7697

(Toll Free): (888) 663-8522

5306 NC Hwy 55, Suite 105,
Durham, NC 27713

After Hours and Weekends:
Call (919) 457-1517 and follow the
prompts for on-call clinician

SHEALogo

(office): (919) 457-1517

(fax): (919) 363-7697

(Toll Free): (888) 663-8522

5306 NC Hwy 55, Suite 105,
Durham, NC 27713

After Hours and Weekends:
Call (919) 457-1517 and follow the prompts for on-call clinician

  • Home
  • Services
  • About
  • Partnership
  • Meet the Team
  • Mental Health Care Forms
  • Contact
  • Careers
  • SHAE Kudos

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