Patient forms
LBHS New Patient Forms
This packet covers psychiatry, medication management and individual therapy visits. It is the paperwork most new patients need.
What is in the packet
- Patient information and demographics
- Medical and psychiatric history, including medications you have tried
- Consent for treatment
- Notice of Privacy Practices acknowledgement (HIPAA)
- Financial responsibility and insurance assignment
- Release of information, if you want us to coordinate with another provider
How to get your copy
Call (502) 454-8800 and we will email or mail the packet to you, or arrive fifteen minutes early and complete it in the waiting room. Bring photo ID, your insurance card, and a list of your current medications and doses.
Please do not email medical details
Standard email is not a secure channel. Return completed forms in person or by the method our staff give you. Nothing on this website asks for medical information.
What happens next
- 1Request your packet by phone or bring your details with you.
- 2Complete every page — incomplete history is the most common cause of a delayed first visit.
- 3Arrive 15 minutes early with ID, insurance card and medication list.
Prefer to talk? Call (502) 454-8800. We respond within one business day.
Starting TMS or LivingFree365 instead? Choose a different packet.
Request an appointment
Tell us how to reach you and what you're looking for. We'll confirm your insurance, answer your questions, and find a time that works. No long intake before you hear from a person.
- We respond within one business day.
- Most insurance accepted, including TRICARE and Medicare.
- In-office visits on Newburg Road, plus telehealth.