Registration & intake
Demographics, contact information, history, current needs, and other information used to begin assessment.
Forms & documents
Use the current form and return it the right way
Harbor uses intake, consent, privacy, authorization, treatment, and records forms. Contact the office for the current approved version and secure return instructions.
A calm, respectful place to beginCommon patient documents
Privacy & confidentiality
Notices and acknowledgments explaining privacy practices and substance-use treatment confidentiality.
Consent for treatment
Consent, patient rights, program expectations, communication preferences, and required acknowledgments.
Authorization to release information
Written authorization identifying what may be shared, with whom, for what purpose, and for how long.
Medication documents
Medication history, informed consent, administration records, and safety information when applicable.
Financial documents
Insurance, assignment, payment responsibility, and billing-related acknowledgments when applicable.
Protect your information
Do not send completed forms, identification, insurance cards, medical records, or substance-use details through a general email or the website callback form. Call Harbor for the current secure submission method.
A form downloaded earlier may be outdated. Confirm the current version before completing or submitting it.
Take the next step
Call (267) 223-5066 Need a form?
Call the office for the current version and secure return instructions.