Harmony Healthcare Admission Forms

Please print out these forms and complete prior to admission.* Any questions and/or concerns, call us at 800.363.4874.

• Patient Registration Form
• Client Questionnaire
• Assessment for Medication
• Medical Advisory Form
• Consent for Treatment
• Bill of Rights
• Consent for Intern to Diagnose, Assess, and Treat Patient
• Financial Responsibility Statement
• Demographic Data

**Important: Please do not sign any of the admission forms until requested to do so in the presence of a Harmony Healthcare employee.