Patient Forms

Click on the links below to download the patient forms.
They can then be printed and filled out before your first visit.

Adult Forms

PBH Adult Intake Packet

PBH Adult Office Policies Client Copy

Child/Adolescent Forms

PBH Child/Adolescent Intake Packet

PBH Child/Adolescent Office Policies Client Copy

Privacy Policy

Notice of Privacy Policy

Release of Information

PBH Release of Information

Please be sure to have all intake paperwork done prior to your scheduled appointment time. Have your paperwork, insurance card, and driver’s license ready for our clerical staff.

  • Prime Behavioral Health - Pickerington Office

  • 647 Hill Rd., Unit B
    Pickerington, OH 43147

  • Phone (614) 833-6900
    Fax (614) 833-6903

  • Pickerington Office Hours:

    • Mon: 7:30A – 7:00P
    • Tue: 8:30A – 6:00P
    • Wed: 7:30A – 5:00P
    • Thu: 7:30A – 7:00P
    • Fri: CLOSED
    • Sat: CLOSED

  • Prime Behavioral Health - Lancaster Office

  • 711 N. Columbus St., Suite 100
    Lancaster, OH 43130

  • Phone (740) 653-6500
    Fax (740) 653-6501

  • Lancaster Office Hours:

    • Mon: 8:30A – 4:00P
    • Tue: 7:30A – 6:00P
    • Wed: 7:30A – 5:00P
    • Thu: 7:30A – 5:00P
    • Fri: CLOSED

  • E-mail Us:
    lacey@carebyprime.com (Email us for either office location)

  • Fees and Insurances:

  • The fee scale is available for our services on our "About Us" page. Remember, you will not normally pay these charges as listed unless you have no coverage and are considered "self pay". Our office staff will be happy to assist clients in addressing insurance or billing issues.

  • Most insurance plans provide coverage for counseling services. Although we have therapists who are "in-network" with all major insurance companies (including Medicare) in this geographic area, not all therapists are on every panel.

  • If your insurance company is not listed, you can confirm our network participation by calling the phone # on the back of your insurance card or give us a call to ask our clerical staff.

  • The fee scale is available for our services on our "About Us" page. Remember, you will not normally pay these charges as listed unless you have no coverage and are considered "self pay". Our office staff will be happy to assist clients in addressing insurance or billing issues.

  • Major Insurances Accepted:

  • Not all therapists are in every network. Please check before scheduling an appointment.

    • Aetna
    • Anthem - All
    • Beacon Options
    • Bureau of Workers Compensation - BWC
    • Caresource
    • Cigna
    • ComPsych
    • Medicaid
    • Medical Mutual
    • Medicare (not available in Lancaster office)
    • NGS
    • OSU
    • Ohio Health Choice
    • Ohio Health Plus
    • Ohio PPO Connect
    • Optima
    • PHCS
    • United Health Care

  • If your insurance company is not listed, you can confirm our network participation by calling the phone # on the back of your insurance card or give us a call to ask our clerical staff.

  • Fee Schedule:

  • Initial visit: $160

  • Individual/couple/family visit: $120-$150 (varies according to time spent and service provided)