CCBS Patient Information Checklist
This form needs to be completed in its entirety for us to best serve our new patients. This form is confidential and encrypted (HIPAA compliant). It will be maintained as part of the patient's medical record.Please contact the office if you need assistance or have any questions (admin@ccbs-sc.com).
Email address *
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This form was created inside of Carolina Coast Behavioral Services. Report Abuse - Terms of Service - Additional Terms