Please download and complete all new client forms before coming into your first appointment. Either print or fax it to our office. If you prefer to complete it in our office, please arrive 15 minutes early. 

New Client Forms

English
Initial Intake Form - MHSA-A1-Compiled.d[...]
Microsoft Word document [146.4 KB]
Informed Consent for Telemedicine Servic[...]
Microsoft Word document [171.3 KB]
Spanish
Initial Intake Form - MHSA-A1-ES (1).doc[...]
Microsoft Word document [123.5 KB]
Confidentiality Form for Better Communit[...]
Microsoft Word document [81.7 KB]
Consent to Release Protected Data Form -[...]
Microsoft Word document [161.5 KB]
HIPAA Confidentiality Regulations Form -[...]
Microsoft Word document [81.6 KB]
Medical Rights Consent Form Revised- MH[...]
Microsoft Word document [88.9 KB]
No Show Financial Agreement Contract - M[...]
Microsoft Word document [81.7 KB]

Please download our Client Handbook for information regarding hours of operation, our code of ethics, rules and regulations, and your rights as our respected client

Client Handbook pdf.pdf
Adobe Acrobat document [935.7 KB]
En Espanol
Consumer Handbook-ES (1).docx
Microsoft Word document [1.1 MB]
Referral Form
Updated Referral Form.docx
Microsoft Word document [76.4 KB]

Thank you for referring your clients for Medication Management at Better Communities. In order to provide the most efficient service to your clients, please review the referral process outlined below.

Referral Process:

1.       Call our  office at  919-844-7755 in order to schedule an appointment. The office staff will make the next earliest appointment for your client. Please keep in mind it might take up to 7 days before your client is actually seen for the first time. Fax the following information to                :

·         Comprehensive Clinical Assessment 

·         Psychological Evaluation (If available)

·         Psychiatric Evaluation (If applicable)

·         Any pertinent notes/ information which provides additional clinical information.

·         Release of information for the sharing of information between your agency and myself. 

·         Name and contact information for clients PCP. This is necessary to ensure continuity of care. Please advise clients that their PCP will be made aware of all medications prescribed by myself.

2.       Please inform your client that they will need to bring all medications they are currently taking on the day of the appointment. Also inform clients to allow 30-45 minutes for their initial appointments. 

3.       Once initial appointment is completed, notes will be forwarded to referring agency within 7-10 business days. All future appointment notes will be forwarded to the referring agency/provider within 5-7 business days. Every effort is made to get notes to you in a timely manner. However, there will be times when notes will arrive a few days late. We appreciate your patience when notes arrive late. As always, pertinent information will be shared with you immediately.  

**Please note: If a release of information is not received, notes will not be sent. The easiest way to avoid not getting notes will be to include the signed release of information form with the faxed referral request. 

Once again, thank you for your referral for medication management. Your business is appreciated. 

Please download and complete the referral form and submit to the agency's fax number at 1-800-480-5850.

 

 
Phone: 919 844-7755
Toll Free: 1-800-420-8301

Fax: 1-800-480-5850
E-mail:
info@better-communities.com

 

 

 

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