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Bluewater Behavioral Health
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  • Our Providers/Key Staff
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Become a patient

fill out this form if you or a dependent would like to become a patient at Bluewater Behavioral Health

New Patient Intake Package

Request or Release information to/from another office

Patients fill out this form if you would like to send or request records from another office.

Authorization to Disclose PHI

Release information to another Person

Patients fill out this form if you give consent to disclose your records to another person.  (Spouse, parent, caretaker etc.)

Authorization to release PHI

CONTROLLED SUBSTANCES AGREEMENT FORM

Patients fill out this form to prevent any misunderstandings regarding controlled substances that you may be prescribed by the providers at this clinic.

Controlled substance agreement form

Printable Forms

New Patient Intake Package (pdf)

Download

Controlled Substance Agreement (pdf)

Download

Authorization for Records (pdf)

Download

Authorization for Release of Information (pdf)

Download

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