Patient Forms

New Patient Forms

Fill out your paperwork online

Now offering a convenient and efficient way for clients to complete their medical forms online. By providing secure digital forms, you can easily provide us with essential information about your medical history and concerns before your first appointment, ensuring personalized and effective care from the start. Simplify the paperwork process and focus on your well-being with our user-friendly online forms.

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Convenience

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HIPAA-Protected

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Streamlined

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Accessibility

Davenport Behavioral Center

New Patient? Get Started Here

Welcome to our online form fill-out section, designed to save you time and streamline your patient care. By completing the necessary paperwork prior to your visit, we can focus on delivering personalized care from the moment you arrive. Say goodbye to physical forms and waiting room paperwork, and embrace the convenience of online form fill-outs for a smoother and more efficient experience. Your well-being is our priority.

New Patient Medical Review & Consent

Start New Patient Consent Form

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    Our New Patient Medical Review and Consent form is designed to put your health first. Completing this online form empowers our experts with essential medical insights, ensuring precise and personalized care right from your initial visit. Your trust is our priority, and your data's security is assured through HIPAA compliance. 

Our New Patient Medical Review and Consent form is designed to put your health first. By completing this online form, you empower our experts with essential medical insights, ensuring precise and personalized care right from your initial visit. Your trust is our priority, and your data's security is assured through HIPAA compliance.

The Mental Health Questionnaire

Complete The Mental Health Questionnaire

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    Explore mental well-being with Davenport Behavioral Center. Our specialized Mental Health Questionnaire helps us understand your unique needs. By sharing insights into your mental health, emotions, and goals, you empower us to create a personalized care plan. Rest assured; your information is handled with the utmost care. Thank you for choosing Davenport Behavioral Center for your journey toward well-being.

Explore mental well-being with Davenport Behavioral Center. Our specialized Mental Health Questionnaire helps us understand your unique needs. By sharing insights into your mental health, emotions, and goals, you empower us to create a personalized care plan. Rest assured, your information is handled with the utmost care. Thank you for choosing Davenport Behavioral Center for your journey toward well-being.

What happens next?

We will review your insurance and form responses and if qualified for a session, we will send you the (Medical Authorization Release and Telehealth Consent form)

Medical Authorization Release Form

The New Patient Medical Review gathers essential medical information to understand your health history and guides our approach in delivering personalized care.


Request the medical authorization release form

Telemedicine Consent Form

The Telemedicine Consent Form acknowledges your understanding and consent for receiving healthcare services through telemedicine, ensuring clear communication and facilitating remote care.

Request the telemedicine consent form

Effortless Patient Forms for Personalized Care

Access streamlined and secure patient forms for your personalized healthcare journey

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(ROS) Review of Systems Form

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By carefully completing the ROS form, you provide us with valuable insights into any symptoms or concerns you may have, enabling us to address them effectively and ensure a thorough evaluation of your health.

Fill this form online
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Patient Health Questionnaire (PHQ-9)

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By completing the PHQ-9, you provide us with essential information to understand the severity of your symptoms and the impact they have on your daily life.


Fill out this form
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Generalized Anxiety Disorder (GAD-7)

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The Generalized Anxiety Disorder Assessment (GAD-7) consists of seven questions that inquire about different aspects of anxiety, such as excessive worry, restlessness, and difficulty concentrating.

Fill out this form
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Mood Disorder Questionnaire (MDQ)

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The Mood Disorder Questionnaire (MDQ) is a series of questions about your mood, energy levels, and behavior changes. 


Fill out this form
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Medical Authorization Release Form

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By completing the Medical Authorization Release form, you grant us permission to access your relevant medical records, enabling comprehensive and informed care.

Fill out this form
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