NOW ACCEPTING CLIENTS IN TENNESSEE AND KENTUCKY! CLICK HERE TO GET STARTED!

Restore Life Behavioral Health, PLLC

(615) 348-5806 CALL TODAY

  • Welcome
  • ABOUT US
  • INSURANCE AND PAYMENT
  • MEET OUR TEAM
  • JOIN OUR TEAM
  • Internship Opportunities
  • CLIENT INTEREST FORM
  • What's New at Restore
  • More
    • Welcome
    • ABOUT US
    • INSURANCE AND PAYMENT
    • MEET OUR TEAM
    • JOIN OUR TEAM
    • Internship Opportunities
    • CLIENT INTEREST FORM
    • What's New at Restore

(615) 348-5806 CALL TODAY

Restore Life Behavioral Health, PLLC
  • Welcome
  • ABOUT US
  • INSURANCE AND PAYMENT
  • MEET OUR TEAM
  • JOIN OUR TEAM
  • Internship Opportunities
  • CLIENT INTEREST FORM
  • What's New at Restore

New Client Intake

New Client Intake Request Form

 

Thank you for your interest in starting mental health services with Restore Life Behavioral Health.

Please complete the form below to begin the intake process. 

Additional intake paperwork will be required after this form is submitted.

If you are seeking couples or family therapy, each participating adult or family member must complete a separate Client Interest Form.

📌 Note: We do not provide services for individuals with sexual offense histories. However, we can assist with appropriate referrals.
 

You can view our therapists' bios on the Staff page to help you choose the best fit for your needs.

We look forward to connecting with you.

Patient Demographics

Attach Copy of Insurance
Attachments (0)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

  • ABOUT US
  • INSURANCE AND PAYMENT
  • MEET OUR TEAM
  • JOIN OUR TEAM
  • CLIENT INTEREST FORM

Restore Life Behavioral Health

hendersonville | Clarksville | Bowling Green

(615) 348-5806

Copyright © 2025 Restore Life Behavioral Health - All Rights Reserved.

Powered by