Forms

Please print these blank forms, complete them at home and then bring them with you to the office. This will simplify and streamline your first visit.

IBC Registration (required) for new patients or existing patients who need to update their information

IBC Fee Agreement & Consent to Treat (required) details the agreement between us regarding IBC policies and procedures

IBC Medical History & Medications for your first appointment with a psychiatrist, or as an update if there is a change in your health or in medications that you are taking

IBC Consent to Release Information allows Integrated Behavioral Care, P.A. to share information with those individuals or organizations whom you may choose (such as a physician, school guidance counselor, etc) and whose input and involvement may be helpful to your care

 

At times current patients may want to forward information to their provider (such as medical reports or a communication from your child’s school). In such situations you may simply print these fax cover sheets (fill in your own name, fax and phone number) to accompany the documents you wish to forward to our office. Cover sheets include a Confidentiality Notice. Be sure to ask your clinician whether it is best to fax to the Summit or to the Bernardsville office.

TO Summit Fax for faxing information to our office in Summit

TO Bernardsville Fax for faxing information to our Bernardsville office