Forms

Medical Professionals:

• Referral Form
• IBHS Written Order Form

Existing Clients:

• Authorization For Disclosure of Protected Health Information (PHI)
• Authorization For Use and Disclosure of Patient Photographic and/or Video Images
• Consent to Email Protected Health Information (PHI)
• COVID-19 Form
• Functional Behavior Assessment (FBA) Consent
• Request to Amend Protected Health Information (PHI)
• Schedule Availability
• Secure Document Submission