For New Clients

~ OUR PROVIDERS ARE NOT CURRENTLY ACCEPTING NEW CLIENTS ~

Thank you for your interest in Gulfcoast Behavioral Health!

To schedule an evaluation with one of our providers, please email the following information to our intake coordinator at intake@gulfcoastbh.com:

  • Patient’s First and Last Name
  • Date of Birth
  • Phone Number
  • a copy/picture (front and back) of your insurance card
  • What services you are requesting? Medication management or therapy?
  • Which provider would you prefer?

We respectfully request that you please allow us up to three (3) business days to verify your benefits and give you a call back to schedule an evaluation.

Dr Joseph Adan is not currently accepting new clients.

Jennifer Holman, APRN is not currently accepting new clients.

Dawn Curtis, APRN is not currently accepting new clients.

Kristina Ramos, APRN is not currently accepting new clients.

Rebecca Shytle, APRN is not currently accepting new clients.

Nicola Haddak, LMHC is not currently accepting new clients.

Patricia Requena, LMHC is not currently accepting new clients.

All the necessary forms can be found on this page so that you can download and complete them at your earliest opportunity. We require your intake forms to be returned to our office 24 hours prior to your scheduled appointment. Without the required documentation, we may need to reschedule your appointment to a later date.

Welcome Letter

Intake Forms

Telehealth Consent Form

Credit Card Authorization Form

Release of Information

 

 

Minors
A parent or legal guardian must accompany anyone under 18 years old for the initial appointment and you must provide copies of any guardianship paperwork when submitting your intake forms. Both parents are required to sign all pages of the intake packet. If you are unable to obtain the other parent’s signature, you must provide legal documentation indicating you have sole medical decision-making responsibilities for your child. Without the required documentation, we may need to reschedule your child’s appointment until documentation can be provided.

Intake Forms for Minors