Appointment Intake Forms

Our Bellin Health Psychiatric Center looks forward to meeting you and your family.

Prior to your initial evaluation appointment, a parent/legal guardian will need to complete the below steps.

  1. Review our Privacy Policy and Patient Rights information.
  2. Complete both intake forms:
    1. Bellin Health Psychiatric Center Ambulatory Services Informed Treatment Consent Form
    2. Bellin Health Psychiatric Center Registration Agreement
  3. After completing each form, you will receive an email within 15 minutes that contains each completed form submission in PDF format. If you do not recieve an email for either form, please be sure to check your spam or junk email folders. Please then forward each PDF to us at bpc.scanning@bellin.org.

If you need assistance, please call us at 920.433.6073.