New client paperwork is available on our patient portal or forms can be mailed to you. Please contact Samaritan at 717-560-9969 for access to the portal or to request the forms to be mailed. New clients may also come in 20 minutes prior to their first appointment to complete the paperwork in the office.
Pursuant to the Federal Trade Commission’s Red Flags Rule, we must request a copy of your insurance card (if applicable) and a copy of a government issued photo ID (such as your driver’s license).
For clients requiring an Authorization to Use or Disclosure of Health Information:
Authorization to Use or Disclose Health Information
This form should be completed and signed and sent via one of these methods:
- Fax at 717-560-9553
- Regular mail to Samaritan Counseling Center, 1803 Oregon Pike, Lancaster, PA 17601
- Dropped off at our office between 8 am and 4 pm Monday through Thursday or 8 am and 2 pm on Fridays.
New client paperwork for adults. These forms are available on our patient portal or can be mailed to you. Please contact the Center at 717-560-9969 for one of these options. If the adult has Medical Assistance, these forms are also required.
