Patient Forms

Please click the link beside the desired forms below. Once you've submitted your form, a member of our intake department with review the information provided and contact you within 1-3 business days. If you have questions regarding the forms below or about the services we offer, feel free to reach out to a patient care representative at the Astra office nearest you.

As a patient of Astra Behavioral Health, LLC, it is our policy that no one will be denied access to services due to inability to pay. A discounted/sliding fee discount program is made available to our patients and is based on family size and income. Astra Behavioral Health will base program eligibility on a person's ability to pay and will not discriminate on the basis of age, gender, race, sexual orientation, creed, religion, disability, gender identification, or national origin. NHSC (click here for details).

General Referral Form
for services other than intensive outpatient or medication assisted treatment

VIEW FORM

Controlled Substance Agreement (CSA)

VIEW FORM

Patient Satisfaction Survey

VIEW FORM

Patient Forms

New Patient Registration

Annual Demographic Update

Auth. for Release of Information

School-based Intake Packet

IOP Enrollment Packet

Recovery Program Referral Form

General Referral Form for services other than intensive outpatient or medication assisted treatment

Controlled Substance Agreement (CSA)

Patient Satisfaction Survey

General Referral Form
for services other than intensive outpatient or medication assisted treatment