Forms

New Patient Packet
This contains all of the forms required to become a new patient.
Demographics Update
Update your demographic information online to avoid delays!

Insurance Update

Update your insurance online to avoid unwanted delays!
Medical Record Release
Use this form to consent to release of your medical record to self.
Informed Consent
Acknowledges your consent to use of psychotropic medications.
PHQ-9
This is a screening tool used by providers.

MDQ (mood)
This is a screening tool used by providers.

GAD-7 
This is a screening tool used by providers.

Cognitive/Executive Scale
This is a screening tool used by providers.

CAGE
This is a screening tool used by providers.

Notre Dame Behavioral Health

CALL US:
623-328-7323
ADDRESS:
Surprise Location: 14811 W Bell Road, Suite 100, Surprise, AZ 85374
Peoria Location: 10210 W Happy Valley Road, Suite 145, Peoria, AZ 85383

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