LSS Behavioral Health Intake Forms

Welcome to LSS Behavioral Health. Thank you for putting your trust in us. We are here to support you on your journey to a happier, healthier you. Before your first visit, please review the following forms and information.

Clients' Rights Booklet

This booklet outlines rights and responsibilities for both LSS as a provider and for you as an individual using LSS Behavioral Health services. 

Notice of Privacy Practices

This booklet outlines how LSS protects your privacy and how we handle private information.

Forms to complete before your first visit

Intake Form

The intake form provides essential information we need in order to start services. It will help you better understand what services will be covered by insurance and/or any costs you will be responsible for before starting services. 

Rights and Notices Consent Form

This form outlines your agreement for participation with LSS Behavioral Health, including legal requirements that might limit confidentiality. You will need to complete this form as part of your agreement for services. 

Once you have completed the Rights and Notices Consent form and the Intake form, you can:

• Print it, fill it out and mail it to the regional office where you made your appointment OR 
• If your visit is in person, you may bring the completed forms to your first appointment. 

We look forward to serving you and supporting you as you work to find solutions for life’s challenges. If you have any questions about these forms, please give us a call. Local phone numbers can be found on our locations page.