Schedule an In-Person or Virtual Meeting for Your Intake to CBH Services
Please fill this form to book an intake consultation with our Welcome Center Team. They can troubleshoot the patient portal or help complete the intake process with you in one of our offices. Once completed, your allocated welcome center will contact you regarding your meeting. If you have any issues with this sheet - you can call 844-224-5264 Ext 104
Sign in to Google to save your progress. Learn more
Name *
Phone Number *
Do you consent for welcome center to text you with appointment information?
Clear selection
Location *
Any Important information you think we should know before meeting you?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Community Behavioral Health. Report Abuse