New Client Information Form
Please complete this New Client Intake Form. The information you provide is confidential and protected, and will not be shared with anyone outside of Exhale Behavioral Health, or used for any other purposes than new client intake. 

Once we receive your information, a member of our intake team will reach out to you within 24-48 business hours. We will send you a link to the intake paperwork that will need to be completed prior to scheduling. Once the paperwork is complete, we will forward available openings. 
Sign in to Google to save your progress. Learn more
I'm completing this form for: *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of exhalebehavioralhealth.com. Report Abuse