Benjamin's Behavioral Health Services, PLLC

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  • Home
  • About Us
    • Meet Our Providers
  • New Patients
    • Appointments
    • Forms
      • New Client Forms
      • Patient Self Quizzes
    • Insurance & Fees
    • FAQs
  • Meet Our Providers
  • Services
  • Specialties
  • Groups
  • Azurite IOP
  • Online Payment
  • Contact
    • Send Us A Message
    • How Did We Do?

    • Address: 8703 Meadowcroft Drive Houston, TX 77063

    Phone: (832) 813-0004

    Fax: (713) 840-7957

    Business Hours
    Monday-Thursday: 9am – 5:00pm
    Friday: 9am – 3:00pm
    Saturday, Sunday: Closed

    New Patient Packet Form

    Benjamin's Behavioral Health Services, PLLC

    Phone: (832) 813-0004 Address: 8703 Meadowcroft Drive Houston, TX 77063

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    • About Us
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    • Patient Self Quizzes
      • Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
      • Alcohol Use Disorders Identification Test (Audit)
      • Center for Epidemiological Studies Depression Scale for Children (CES-DC)
      • Generalized Anxiety Disorder 7-item (GAD-7) scale
      • PCL-C PTSD Checklist
      • PCL-S PTSD Checklist – Specific
      • The Mood Disorder Questionnaire
      • Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
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    • Meet Our Providers
      • Ciara Jackson
      • Daymar Blanco, LPC-Associate
      • Dominique Webb, MA, NCC, LPC-Associate
      • Ebony Meremikwu
      • Emilie Kestner
      • Kife McDowell, PMHNP-BC
      • Maritza Mata, LPC
      • Maritza Mata, MA
      • Remmie Lockhart, PMHNP-BC
      • Shama Rasheed, M.D.
    • Forms
      • Consent for Non-Parent to Bring Minor Child
      • Consent Form For Treatment of Minors with Divorced or Separated Parents
      • Consent to Release Form
      • Controlled Substance Policy Form
      • Credit Card Authorization Form
      • New Patient Intake Form
      • New Patient Packet Form
      • New Patient Packet Form – Spanish
      • Notice of Private Practices
      • Office Policies
      • Symptoms Experienced Form
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