COVID-19 WellSpan MENU Menu Menu Menu GET HELP 24/7 CALL 800-932-0359 ABOUT US COPYRIGHT About Us : Copyright Copyright The information presented on WellSpan Philhaven's Web site comes from a variety of sources, including not only official WellSpan Philhaven departments and programs, but also unofficial sources and individuals. Although every effort is made to present current and accurate information, the Hospital does not author or edit all of the pages presented here and therefore cannot assume responsibility for all information. The author of each Web page is responsible for the content of that page and is expected to abide by Hospital policies and local, state, and federal laws. All other information presented on our pages is considered copyright of WellSpan Philhaven Behavioral Healthcare Services. Report Possible Infringement To report possible copyright infringement, contact: Office of Network Administration 283 South Butler Road P.O. Box 550 Mt. Gretna, PA 17064 Phone: (717) 273-8871 FAX: (717) 270-2449 E-mail: netadmin@philhaven.org WellSpan Philhaven MAIN LOCATION 283 S. Butler Road P.O. Box 550 Lebanon, PA 17064 GPS navigation city: Lebanon Get Directions Other Philhaven Locations Find us on PHONE Local: 717-273-8871 Toll Free: 800-932-0359 Financial Assistance Program Joint Commission Accreditation Certified

COVID-19 WellSpan MENU Menu Menu Menu GET HELP 24/7 CALL 800-932-0359 PATIENT RESOURCES FORMS Patient Resources : Forms Please review or download the information or documents you need from the list below. Forms are listed alphabetically for ease of access. Filter by Category: Show all categories Programs & Services Authorization to Use or Disclose Health Information (English) Authorization to Use or Disclose Health Information (Spanish) New Patient Packet for WPH Adult Outpatient Services - York and Adams Co New Patient Packet for WPH Child and Adolescent Outpatient Services -York and Adams Co WellSpan Philhaven MAIN LOCATION 283 S. Butler Road P.O. Box 550 Lebanon, PA 17064 GPS navigation city: Lebanon Get Directions Other Philhaven Locations Find us on PHONE Local: 717-273-8871 Toll Free: 800-932-0359 Financial Assistance Program Joint Commission Accreditation Certified