Register Below

(Please complete one form per family group)

Names of Attending Family Members / Supporters

Email of Primary Contact:

Name of Family Member at Silver Hill:

Relation to Patient:

Residential Program your family member is attending: River House (Resilience Program) Scavetta House (DBT-S Program) Steward House (Executive and Professionals Program)

Social Worker that is managing your family member's treatment (If Known):

Dietary, Allergies or Accessibility Needs

Digital Signature

Date:

Comments