Mental Health Care Forms/Feedback

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
• Release of Information Form

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

Click the link below to provide feedback

• Feedback