We created our forms with Adobe Acrobat extended features to enable users to enter data, save the completed form, print, and attach to e-mail. For best results, it is recommended to use the latest version of Adobe Acrobat Reader - download for free.
Fill-out the following forms prior to the initial session. Tap or click on the patient form link and download or save the form to your device. Open the saved form and enter your information. When finished, save the completed form again to ensure your data is kept.
You can submit your form back to us by one of the following methods:
1) Attach the saved document to your e-mail and send to Intake@hbinetwork.com.
2) Print and mail to: Human Behavior Institute - 2740 S. Jones Blvd, Las Vegas, NV 89146.
3) Print the completed forms and submit them to the front office on the day of your first visit, at least 15 minutes prior to your appointment.
ADULTS (Ages 18 years or older)
CHILD OR ADOLESCENT
If you are being prescribed a controlled substance, this form is required to be signed in the office during your medication management appointment.
This form must be completed and signed in front of a Notary Public, if NOT witnessed by an authorized HBI representative. Read carefully the INFORMATION FOR INFORMED CONSENT detailed on the form. Pursuant to Nevada Laws, you may have to pay a fee per page due prior to the release of patient records.
This document provides some useful information on your first visit. You can also go to the Member/Patient page for more information.
These are not intended to replace professional clinical judgement. CONSULT A PROFESSIONAL CLINICIAN for proper diagnosis.
NOTE: Providers are responsible for using HIPAA compliant technology when saving and transmitting protected health information (PHI).