Patient Forms

Please follow the below steps to complete Libertas’s intake forms prior to treatment.

Please follow the below steps to complete Libertas’s intake forms prior to treatment.

  1. Click here to download the necessary forms using Adobe Acrobat
  2. Carefully read each form
  3. On each form, fill in the text boxes with your name, date and time of completion
  4. Save each form
  5. Upload and send all completed forms to Libertas’s confidential e-mail: libertas@hshs.org. Please include the date of your appointment in the subject line.

Mobile instructions

If you have questions, please call Libertas in