Weber Behavioral Health Forms

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Release of Information
Click the following link or download and print the PDFs below
Authorization to Use & Disclose Protected Health Information

roi_therapist.pdf
File Size:	40 kb
File Type:	pdf

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roi.pdf
File Size:	40 kb
File Type:	pdf

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roi_pcp.pdf
File Size:	40 kb
File Type:	pdf

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​Authorization Regarding Communication Methods
Click the following link or download and print the PDF below
Online Authorization Regarding Communication Methods Form

communication_methods.pdf
File Size:	7 kb
File Type:	pdf

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Consent for Treatment
​Click the following link or download and print the PDF below
Online Consent for Treatment Form

consent_for_treatment.pdf
File Size:	118 kb
File Type:	pdf

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Consent to Disclose
​​Click the following link or download and print the PDF below
Online Consent to Disclose Form

consent_to_disclose.pdf
File Size:	8 kb
File Type:	pdf

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​HIPAA
​​Click the following link or download and print the PDF below
Online HIPAA Form

hippa.pdf
File Size:	113 kb
File Type:	pdf

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Medical History
​​Click the following link or download and print the PDF below
​Online Medical History Form

medical_history.pdf
File Size:	151 kb
File Type:	pdf

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​Registration Information
​​Click the following link or download and print the PDF below
Online Registration Information Form

registration_information.pdf
File Size:	417 kb
File Type:	pdf

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Rights and Responsibilities
​​Click the following link or download and print the PDF below
Online Rights and Responsibilities Form

rights_and_responsibilities.pdf
File Size:	140 kb
File Type:	pdf

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