The Intake Process

1. Click on the link below to download our intake request form.

Intake Request Form

Complete the form and fax it back to us at (603) 760-1949. If you wish to return the request via email, please call us at 603-760-1942, and we will explain how to send us the form securely. Our intake coordinator will review your request and call you to discuss next steps. We will contact your insurance carrier to determine if your plan is covered and to check your benefits. Please note that we receive a large volume of intake requests and respond to them in the order they are received.

If your child is anxious about starting our program or unsure if he or she is willing to attend, we encourage you to do a walkthrough of our office prior to scheduling an intake. A walkthrough is a brief (15-minute) tour of the facility and opportunity to meet our staff and ask questions. Walkthroughs are offered most days of the week at 11:30am or 11:45am. To schedule a walkthrough, please call our front desk.

2. Complete Forms and Schedule Intake Appointment

We ask that all clients with access to email complete their intake forms electronically via our client portal. You will receive a welcome email with a link to register for a free client portal account. Registration is easy—simply create a username and password. You will receive a second email with a link to your intake forms, which will allow you to log in to the portal, electronically sign, and submit all of your intake forms. Please be aware that the Adolescent Health History form is lengthy (45 minutes to complete, on average) and must be completed in one sitting (you cannot save and return to finish it later). Once your paperwork is complete, we will contact you to schedule the intake appointment.

 

3. Attend the Intake Appointment

When you arrive for your intake, we will first ask your child if he or she is willing to attend our program, because it is 100% voluntary. If so, we will then have your child complete a brief pre-assessment, have the parent/guardian complete any necessary forms, and take a copy of your insurance card. The child and parent/guardian will then meet individually and together with one of our clinicians, who will ask questions about the child’s symptoms and history in order to make preliminary diagnoses, assess safety, and determine if the child meets criteria for our level of care. If your child is admitted to PHP, he or she will have the opportunity to start that day or the following day. The appointment lasts an average of 90 minutes.