SBBH Intake Screening
This intake form is for prospective patients of Santa Barbara Behavioral Health who are seeking treatment. Answering some questions will help us discover if we can serve you. If we can, you will also help us learn if you can use your health insurance to pay all or some of the costs. You will need your insurance card to answer some of the insurance coverage questions.

Please note that we are not able to treat patients through standard Medicare insurance.

If you prefer to have our staff review these questions with you over the phone instead of completing online, please call us at (805) 681-0035.

If you complete this form and receive the message that we are likely able to provide clinical services to you, we will process your information and call you back to schedule an initial appointment.
Never submit passwords through Google Forms.
This form was created inside of Santa Barbara Behavioral Health. Report Abuse - Terms of Service