Patient Information

Required Forms

Prior to your scheduled assessment, please complete the forms below. 



Please email completed forms to, fax to (901) 751-8105, or bring them to your child's scheduled assessment.

                                                          Please bring a copy of your child's immunization record to your assessment.                                                             

Please bring a copy of your child's most recent psychological and psychoeducational test results.



Additional Forms



Program Information


Program hours are Monday-Friday, 8:00am - 2:00pm (Summer hours are 9:00am - 2:00pm)

The average length of stay at Daybreak is seven weeks, or 35 treatment days.

Daybreak is an approved provider for most insurance carriers*. Should a child meet the criteria for admission, insurance coverage is checked and an estimated out of pocket amount is provided. This estimate is based on the information received from the insurance company prior to admission.


*We do not accept TennCare.

Refresh Mental Health, an Insurance Friendly Company