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Outpatient Programs & Services ? ? ? ? ? ? ? ? ? UPPER BAY COUNSELING & SUPPORT SERVICES, INC. Non-Profit Org U.S. Postage PAID Elton, MD Permit #30 Services individual & family medication evaluation
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How to fill out a services form for behavioral health:
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Answer the questions related to your medical history, including any previous mental health diagnoses or treatments. Be thorough and honest in providing this information as it will help the behavioral health professional understand your unique needs.
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Keep a copy of the completed form for your records before submitting it to the relevant behavioral health service provider.
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Information such as type of service provided, dates of service, patient demographics, insurance information, and billing details must be reported on services form behavioral health.
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