Patient Forms

New Patient Forms

If you are a new patient and have been registered online or by phone and directed to this page, please tap the appropriate button below. Completing this prior to your appointment is required. If you have not yet registered with SBBH, please tap to schedule an appointment or call our office (805) 681-0035.

Request to Release Information

To manage the optional transfer of your protected health information, make your request below. 

Form I: Third Party Release

Use this form to authorize the release of your records from SBBH to a third party such as a physician, attorney, school, or for your own records. Also use this form to authorize an individual to schedule appointments on your behalf.

Authorization for Release of Medical or Mental Health Information | En Español

Alternatively, if you are the patient’s guardian:
Form | En Español

Form II: Records Request 

Use this form to authorize a third party such as another individual or doctor’s office to send copies of your records to your SBBH provider.

Authorization for Release of Medical or Mental Health Information | En Español

Alternatively, if you are the patient’s guardian:
Form | En Español

Authorization for Third Party Appointment Scheduling

To authorize payment on behalf of a patient, see options below.

If you are willing to guarantee payment for the exceptional situation in which a third party is making an appointment for a patient:

Authorization for Third Party Appointment Scheduling | En Español

Schedule an appointment and start your journey today.