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919-276-4005
About
About Bright Path
Our Team
Our Facility
Clinical Internship
Programs
Our Programs
Partial Hospitalization Program
Intensive Outpatient Program
Virtual Intensive Outpatient Program
Parent Coaching Group
What We Treat
ADHD
Anxiety
Major Depression
Mental Health
Obsessive Compulsive Disorder
Self-Harm
Suicidal Ideation
Resources
Teen Mental Health Blog
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Mental Health Disorders
Patient Survey
Patient Grievance
Release of Information
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Referrals
About
About Bright Path
Our Team
Our Facility
Clinical Internship
Programs
Our Programs
Partial Hospitalization Program
Intensive Outpatient Program
Virtual Intensive Outpatient Program
Parent Coaching Group
What We Treat
ADHD
Anxiety
Major Depression
Mental Health
Obsessive Compulsive Disorder
Self-Harm
Suicidal Ideation
Resources
Teen Mental Health Blog
Insurance
Mental Health Disorders
Patient Survey
Patient Grievance
Release of Information
Admissions
Admissions
Referrals
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Title:
Admissions Coordinator
Camille Tate
April 3, 2024
Have a question?
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Creating a safe, judgment-free space where adolescents feel welcomed and valued
Are you filling out this form for a loved one or for yourself?
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For myself
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Last Name
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Phone
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Date of Birth
(Required)
MM slash DD slash YYYY
Loved One Name
(Required)
Email Address
(Required)
First Name
(Required)
Last Name
(Required)
Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Your Insurance Provider
(Required)
Your Policy Number
(Required)
Your Email
(Required)
Your Message
(Required)
Your information is secure & confidential
Have a question?
Contact Us Today
Creating a safe, judgment-free space where adolescents feel welcomed and valued
Are you filling out this form for a loved one or for yourself?
(Required)
A loved one
For myself
First Name
(Required)
Last Name
(Required)
Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Loved One Name
(Required)
Email Address
(Required)
First Name
(Required)
Last Name
(Required)
Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Your Insurance Provider
(Required)
Your Policy Number
(Required)
Your Email
(Required)
Your Message
(Required)
Your information is secure & confidential
