Forms & documents
Paperwork, minus the clipboard
Complete intake online in about 15 minutes, or download printable forms and upload them when you're done. Either way, your first visit starts with care, not paperwork.
Download
Printable patient forms
Prefer pen and paper? Download and print at home, then upload the completed forms below or email them to intake@freedomhealthbehavioral.com before your video visit.
- New Patient Intake PacketThe full intake, printable for those who prefer paper.PDF
- Telehealth Consent FormRequired once before your first video visit.PDF
- Release of InformationLets us share records with another provider, school, or family member you choose.PDF
- Financial PolicyBilling, copays, and missed-appointment policy in plain language.PDF
Complete online
New patient intake
Everything we need before your first appointment, in one form.
New patient intake
Completing this ahead of time keeps your first video visit focused on care, not paperwork. Prefer paper? Download the printable version from this page and upload it when done.
Please share only the details needed for us to respond, and do not use this form for urgent needs. Information you submit is sent to our intake team; like most online forms, it should not be considered a fully secure channel for detailed medical history. Sensitive clinical information is best shared by phone or during your visit. See our Privacy Policy and HIPAA Notice.
If this is an emergency, do not use this website. Forms and messages are not monitored for urgent medical needs. In a crisis, call or text 988, call 911, or go to the nearest emergency room.
Filling this out for a child?
A parent or legal guardian should complete the form and add their own name in the guardian field. Upload or email any custody paperwork that affects consent before the first visit.
Send to us
Upload completed documents
Finished paper forms, insurance cards, prior records, referral letters: send them here and they'll reach your chart before the visit.
Upload documents
Send completed forms, insurance cards, prior records, or referral letters ahead of your visit.
Please share only the details needed for us to respond, and do not use this form for urgent needs. Information you submit is sent to our intake team; like most online forms, it should not be considered a fully secure channel for detailed medical history. Sensitive clinical information is best shared by phone or during your visit. See our Privacy Policy and HIPAA Notice.