Forms

Help us find the right place for you.

The easiest way to get started with Veritas is to give us a call or complete our general contact form. Our Intake & Admissions Team can answer your questions and, if you’re ready, collect the information we need to begin the admissions process. Below are our commonly requested forms.

Please fill out forms accurately and in their entirety.

We appreciate your time completing these forms so that we can find the best level of care and fit of facility for you or your loved one. All forms will be reviewed by a Master’s-Level Clinician on our Intake & Admissions Team, and you will be contacted within one business day of submission.

Please note that submitting these forms does not in any way commit you to treatment. It simply allows us to learn more about you or your loved one and your treatment needs.

Basic Intake Forms

These two brief forms are required to begin treatment discussions. If you’d like help filling them out, please give us a call.

  • Veritas Intake Form: This form provides us with the basic information we need about you or your loved one to begin treatment discussions.
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  • Release of Information Form: This form gives us permission to talk to your doctors, family members, and others you would like to have involved with your care. Please submit one form for each person. Complete this form if you are new to Veritas Collaborative, or if you simply want an ROI on file for future use.
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General Forms

Some of these forms will be required if you choose Veritas treatment for you or your loved one. Again, our Intake & Admissions Team can help you complete them.

  • Insurance Information: You can find our current list of accepted insurance providers here. Even if your provider is not listed, we can work with them to create a single-case agreement and a care plan that is right for you.
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  • Healthcare Provider History: This form tells us what medical or clinical treatment you or your loved one may have received in the past six months, whether for an eating disorder or other conditions.
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  • Custody/Guardianship Documentation: This form is required only if there has been a legal ruling regarding custody or guardianship of an incoming patient.
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  • Request for Records: Complete this form if you would like your records to be send from Veritas Collaborative to another party. The completed form will be kept on file for additional future use.
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Location-specific forms

Charlotte

Appointment policy

Preliminary assessment – Child/adolescent

Recovery Starts Here

If you have questions about anything - eating disorders, our programs, specific needs or concerns - or you'd like to schedule an initial phone assessment or a comprehensive in-person medical assessment, please give us a call or complete our contact form. Our Master's-Level Clinicians are here to help.

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