Forms

Pelorus Elder & Behavioral Health is an “in-network” provider for Medicare, United Medicare plans, Cigna, Aetna, and Horizon Blue Cross-Blue Shield**.

If you fit the Pelorus Elder & Behavioral Health patient profile, please click the following link to download and complete the new patient intake packet. Once delivered (by fax, email, mail or in person) to our office, we will schedule your first appointment.  Download PDF Form

If you have questions about the Pelorus Elder & Behavioral Health patient profile, please contact us.


If you fall outside of the Pelorus Elder & Behavioral Health patient profile, but would still like to be considered for an appointment with our practice, please download the following link and complete the Prospective Patient Brief Questionnaire. Download PDF Form

If you have questions about the Pelorus Elder & Behavioral Health patient profile, please contact us.


*Horizon BCBS members only, please note:  Some policies “carve out” the mental health coverage to a separate company called Value Options.  Our practice is NOT an in-network provider for Value Options.  You will only be able to find out if your Blue Cross-Blue Shield policy is associated with Value Options by calling the contact number for “mental health services”, and asking if Value Options is associated with your policy.   Calling the general “member services” number on your card may not provide you with the accurate information regarding your mental health coverage (they may not know that your policy uses Value Options).  Again, you must call the phone number specifically listed for “mental health services” on your insurance card to determine whether Value Options provides the mental health coverage for your Horizon Blue Cross-Blue Shield policy.