DOWNLOAD FORMS | surprisebh

Surprise Behavioral Health

Ruth J. Cohen, LMFT
Surprise, AZ 85387
623-337-3388

Are you ready for your journey to begin?

Download Forms

(PDF Files - Open & Print)

What to Expect on Your First Visit

Credit Card Payment Authorization Form

Individual-Therapy After Couples Therapy Agreement

Insurance Verification Form

Notice of Privacy Practices

Notice of Privacy Practices Receipt

Social Media Policy

Adult Information Form

Couples Therapy Participation Agreement

Adolescent Information Form

Client Intake Form

Ready to Leave Therapy

HIPAA Authorization Form

Quick Contact

Tel: 623-337-3388

Email: Click here

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