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Registration

First Time users, and those who do not already have a CLIENT IDENTIFICATION NUMBER please use the form below.

Liberation Way takes our client’s privacy very serious.  We abide by HIPAA (Health Insurance Portability and Accountability Act) laws, which require data privacy and security provisions for safeguarding medical information.

  • Name

  • Contact Info

  • Required phone number format: (###) ###-####
  • Required phone number format: (###) ###-####
  • Client Info

If you can provided proper information and are on the client’s HIPAA release you will receive an email response within 24 hours. That email will contain a unique client ID code which you will need to use to identify the client on the submission forms.  If you are not on the approved list, or if the client is not registered with us, we cannot contact you back with an identification number, nor can we confirm or deny his or her presence in our program.

If you have any questions or concerns, please email Forms@LiberationBehavioralHealth.com