Patient Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.

 

Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

Authorization to Disclose Patient Information
Please fill out this form to send or receive your medical records. Make sure to include the recipient in detail, nncluding where we need to fax, mail or email the records. This will ensure prompt arrival to either you or the facility or entity that is in need of your records. Medical Records are accessible to you, or anyone who needs to access your records, at any time. However, due to the time it takes our Staff to search, prepare, organize and transfer this paperwork quickly and efficiently, there is a fee that is due before each Medical Records request can be fulfilled. Please refer to our Fee Schedule to find the fee for this and other services that Jones Behavioral Health, Inc. offers.
JBH Medical Release Consent Form.pdf
Adobe Acrobat document [4.0 MB]
Intake Questionnaire
JBH_2016 Intake Questionnaire.pdf
Adobe Acrobat document [480.4 KB]