Child and Adolescent Partial Hospitalization Forms

Dear Parent or Guardian,

Welcome to Pennsylvania Psychiatric Institute and thank you for your Interest in our Child and Adolescent Partial Hospitalization Program. Our facility strives to provide the highest level of mental health care in both our community and the surrounding areas.

Child and Adolescent Partial Hospitalization Forms

To enroll, please consult with Admissions first

Begin the admissions process by calling 866-746-2496 so we can review your eligibility for this program.

Upon approval, complete these forms

Download these PDFs to your computer first. Open them and fill them out. Save them back to your computer. Then attach both PDFs to an email and send it to

If you have a court documentation pertaining to legal and/or physical custody of the dependent child, please email it to or fax it to 717-782-6423 or mail a copy to…
Pa Psychiatric Institute
Attn: Admissions Dept
2501 N 3rd Street
Harrisburg, PA 17110

After your information has been received

We will contact you to discuss scheduling an assessment with our psychiatrist. At that appointment, we ask you to bring the following items:

  • Insurance card(s)
  • Parent identification (driver’s license)
  • All current prescription medication in original bottles
  • Copy of Individualized Education Plan (if applicable)

Should you require assistance in completing the information in this packet, or if you have questions regarding content, please feel free to contact the Admissions Department, 24 hours a day, seven days a week, at 717-782-6493 or toll-free 1-866-746-2496.

Admissions Department Staff