Submit Intake Form

Our dedicated team is here to guide you and your family through a seamless intake process to ensure you receive the support you need. Follow the simple steps below to inquire about our services.

Complete Our Secure Intake Form

Take a few minutes to fill out our safe and secure Intake Form linked below. This form covers the essential details such as demographics, insurance information, and any psychological evaluations for your child (if applicable). Clicking the button below will take you to a secure, HIPAA-compliant form that our Intake Team will review after you submit.

What to Expect During Our Intake Process

You Will Hear From Our Intake Team

Following your intake form submission, you can expect to hear from a member of our Intake Team within 24 hours. We will reach out via email, phone, and text message to discuss next steps. During this conversation, we will confirm the details on your intake form, review insurance information, and assess availability for services. Don’t hesitate to ask questions. Our team is here to assist you and your family!

If you don’t see our communication in your inbox, please check your spam folder.

Submit Necessary Information

To expedite the intake process, you can send the following information to our Intake Team at [email protected] prior to your conversation.

  • Front & back photos of your insurance cards
  • A copy of your child’s full psychological evaluation (if applicable)

Insurance and Benefits Verification

Once we have initiated the intake process, our team will verify your insurance coverage and benefits, providing you with a summary outlining what is covered in your plan as well as an overview of billing expectations.

Start Your Intake Form Today

At Surpass Behavioral Health, we aim to make your experience smooth and seamless. We look forward to supporting you and your family on the journey to improved quality of life!