Behavioral Health Consent Form

All patients in our Behavioral Health Clinic are required to review, sign and return a Consent to Treat form, typically at their initial appointment.

If your first appointment is remote (video or phone), or if you’re asked to complete it afterwards for any reason, please follow these instructions:

1. Click the button below to access the form
2. Complete it by writing or typing in it (note that your signature must be hand-written)
3. Submit it by emailing it to [email protected]

Complete Behavioral Health Consent Form (PDF)

If you have questions, please ask your UHS Behavioral Health clinician by sending a message through the Patient Portal.  

Thank you in advance for completing this form!