IOP Forms

Referring Providers

We look forward to collaborating with you and appreciate the care and attention you provide to patients with all forms eating disorders. The following forms are required to be completed by you to ensure we have the necessary information to proceed with insurance authorizations and admission.

Admissions Referral Form – Physician

Admissions Referral Form – Clinician

Admitting Clients

Whether you are stepping down from a higher level of care, or making a step up to receive more support than office visits, we are honored that you have chosen our program for this phase of recovery. Our team will make every effort to ensure that you receive the highest standard of care and will utilize every opportunity to ensure your insurance company authorizes you to participate.

When you arrive for your first day of IOP, you’ll meet with one of our clinicians for orientation to the program. There, you’ll be required to fill out the following forms. To expedite this process, please print these forms out and bring them with you to your orientation.

IOP Rights Consent

IOP Financial Agreement

If you have never been a client at Chrysalis Center, or it has been over six months, you will also need to fill out the following packet of information:

IOP Intake Forms

For More Information about our IOP program, please contact our Director of Professional Relations, Alexis Hunter at 910-726-1228 or

About Us

At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More

Client Satisfaction Survey


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Fri: 8AM – 4PM

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