Patient Forms and Downloads
The 18 and Up Patient Forms are:
New Patient Packet 18 and Older - Includes all forms belowWelcome to RCBM - New Patient General Information (PDF)
Patient Information Form (PDF)
Payment Policy (PDF)
Adult Confidential History Form (PDF)
HIPAA Privacy Notice (PDF)
EMR Information Form (PDF)
PLEASE NOTE: If you have been asked to complete the ‘EMR Information Form,” you do not need to complete the medication list within the “Patient Information Form,” as this information is contained within the former.
The Under 18 Patient Forms are:
New Patient Packet Under 18 - Includes all forms belowWelcome to RCBM - New Patient General Information (PDF)
Patient Information Form (PDF)
Payment Policy (PDF)
Child/Adolescent/Parent Confidential History Form (PDF)
HIPAA Privacy Notice (PDF)
EMR Information Form (PDF)
PLEASE NOTE: If you have been asked to complete the ‘EMR Information Form,” you do not need to complete the medication list within the “Patient Information Form,” as this information is contained within the former.
Other Important Forms
Release of Information (PDF)Please Note: There will be a $30 processing and additional $5 shipping and handling fee for the copy and transfer of medical records. We appreciate your cooperation.
Patient Change of Information Form (PDF)
Clinical Research Trials
RCBM is currently involved in clinical trials on the following research topics:
- Major Depressive Disorder (trial for adults ages 18-65)
- Anxiety (pediatric patients ages 6-17)
- AD/HD -Attention Deficit/Hyperactivity Disorder: (Children and adolescents ages 6-17)
- Smoking cessation study for adolescents: (ages 12-19)
Please contact our research coordinators for more information!
Call (248) 608-8800
Karolina at ext. 249 or Emma at ext. 226
Book Reviews
