Patient Forms

Please download the following forms to your desktop. Once downloaded you can either fill out directly and submit them via email or you can print them out and bring them with you prior to your appointment. Forms requiring a Social Security Number will be entered at time of appointment and not submitted electronically.

Urgent Behavioral Health Care accepts most major insurances, including Humana, BCBS, Aetna, Tri-Care and UHC; and most Medicare, Medicaid and managed care, including Superior, Community First, Molina and AmeriGroup. We will verify coverage prior to appointments. – Cash pay also accepted.

Urgent Behavioral Health Care accepts most major insurances, including Humana, BCBS, Aetna, Tri-Care and UHC; and most Medicare, Medicaid and managed care, including Superior, Community First, Molina and AmeriGroup. We will verify coverage prior to appointments. – Cash pay also accepted.