Timko Behavioral Healthcare

Adult Intake Packet

• Intake/History 

• Confidentiality

• Payment Responsibility

• HIPAA

• Release Authorization

Child & Adolescent Intake 

• Intake/History

• Confidentiality

• Payment Responsibility

• HIPAA

• Release Authorization

• Child Symptom Checklist

In an effort to maintain electronic records, we'd prefer if you'd contact us with your phone number and email adddress and we will send you an intake packet to complete online. The above forms are the basic information we will be sending you to complete.