Asheboro Behavioral Medicine, PLLC

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New Patient Forms are below for Adults and Children/Adolescents All forms are in Adobe PDF and maybe printed and faxed to (336)232-1786. To expedite your check-in at your first appointment please include an enlarged copy of the front and back of your insurance card and fax it along with the other forms you fax in advance of your appointment.

You may of course simply print them, complete them and bring them to your first appointment.

If your insurance requires prior approval it is your responsibility to attain the approval prior to your appointment, otherwise you may be liable for that appointments entire bill.

Commercial Insurance and Self-Pay Forms

Child and Teen New Patient Form     Adult New Patient Forms
Physician Referral Fax Form