BHS Intake Forms

We are open for new patients. Please call us at 703-659-9900 for more information and to schedule an appointment.

New Client Forms

#1a Minor Client Contact Information

#1b Adult Client Contact Information

#2 Behavioral Health Service Agreement 

#3 BHS Rights and Responsibilities 

#4 BHS HIPPA Acknowledgement 

#5 Authorization to Release Health Information

#6 Medication Consent Form

Once completed please return the forms by fax or mail. 

By fax - You can fax the completed forms to 866-337-3187

By mail - Please mail the completed forms to us here -

Youth For Tomorrow, Behavioral Health Services
14000 Crown Court, Suite 101
Woodbridge, VA 22193