Paperwork for Admission into Therapy
The following forms must be submitted for admission into PBJ Connections' group, individual and familiy therapy programs.
- PBJ Connections Treatment Policies (Adobe PDF)
- Application and Health History (Adobe PDF)
- Consent for Treatment (Adobe PDF)
- Emergency Consent (Adobe PDF)
- Privacy Policy (Adobe PDF)
- Conscent to Disclose (Adobe PDF)
- PBJ Connections Liability Waiver - Minor (Adobe PDF)
- PBJ Connections Liability Waiver - Adults (Adobe PDF)
The facilities where we deliver our services require liability waivers in addition to those forms required for program admission. Please check with us to determine which of these waivers you are required to complete.
- Otterbein College Liability Waiver - Minor (Adobe PDF)
- Otterbein College Liability Waiver - Adults (Adobe PDF)
- PBJ Dressage (Pataskala Facility) Liability Waiver - Minor (Adobe PDF)
- PBJ Dressage (Pataskala Facility) Liability Waiver - Adults (Adobe PDF)
Equine Assisted Therapy Additional Paperwork
These two forms should be completed if they are applicable to your situation.