Patient Registration

PREPARING FOR YOUR FIRST VISIT


1.) Complete and submit all registration documents prior to your first appointment.

ADULT REGISTRATION
CHILD REGISTRATION
ADULT REGISTRATION - SPANISH
CHILD REGISTRATION - SPANISH

2.) Arrive 3O minutes before your first appointment so we can ensure all your information is correct and have your photo ID and insurance card ready.

To review insurance and payment details, for questions, or if you need assistance filling out the registration documents, ask a Patient Services representative at check-in or call us Monday - Friday from 8 AM - 5 PM and we will be happy to assist you.

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 ADDITIONAL PATIENT RESOURCES

Only you or your personal representative have the right to access your protected health information.

REQUEST RECORDS

Only you, your Mental Healthcare Representative or Healthcare Representative can allow a 3rd party to access your private health records.

RELEASE RECORDS
RELEASE RECORDS - SPANISH

If you choose to admit yourself into Bowen Health Psychiatric Hospital voluntarily, you’ll need to fill out this packet.

ACCESS PACKET
REQUEST RECORDS - SPANISH

Only you, your Mental Healthcare Representative or Healthcare Representative can allow a 3rd party to access your private health records.

RELEASE RECORDS

An appointed Mental Healthcare Representative can make mental healthcare decisions on your behalf if you are incapable of doing so.

APPOINT REPRESENTATIVE
APPOINT REPRESENTATIVE - SPANISH

An appointed Mental and Physical Healthcare Representative can make mental and physical healthcare decisions on your behalf if you are incapable of doing so.

APPOINT REPRESENTATIVE
APPOINT REPRESENTATIVE - SPANISH

If you choose to conduct your appointment by Telehealth you are required to submit a Telehealth Consent Form prior to the visit.

ACCESS CONSENT

If you or your child are registered as a participant in the Department of Mental Health and Addiction (DMHA) Supported Clients (DSC) Program, you are entitled to certain rights during your treatment.

ACCESS RIGHTS

As a patient, you have certain rights and responsibilities. Some rights are guaranteed under federal law and some we pledge to ensure you are treated with dignity, compassion, and respect.

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Depending on your family income, you may be eligible for fee assistance discounts. Complete a Financial Assistance Assessment for consideration.

ACCESS ASSESSMENT
ACCESS ASSESSMENT - SPANISH

We value your feedback because it helps us provide the best patient experience possible. If you have a concern, suggestion, or you want to recognize a staff member who went above and beyond, please let us know!


Patient Concerns and Support

We believe each patient should be empowered with the skills to navigate and advocate for their healthcare. If you believe your care has not been provided fairly, we will provide a Patient Advocate to guide you through the grievance process by calling (574)269-0574. You may also call the Consumer Service Line for the Indiana Division of Mental Health at (800) 901-1133.

Please do not use these phone numbers for emergencies. If you or someone you know is in crisis, walk in our door, call/text 988 or 800-342-5653, or go to the nearest Emergency Room. 

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