The following forms are available here for download:

 

1. Map and Address for Wellness Beyond Words

2. New Client Questionnaire (Print and complete all 6 pages.)

3. Our Agreement (Print and sign. Keep or request a copy for your records.)

4. Notice of Privacy Practices (Print and sign page 3. Keep the full document for your records.)

 

 

Note to new clients: Please print, review and complete the Questionnaire, Agreement and Privacy Practices forms (#2-4 above). If you would prefer, you can complete these for your second session instead of your first.

 

 

A note on health insurance: If you will be using health insurance to help cover your session fee, be certain to call them prior to our first session to ensure the following:

 

• I am on your exact network

• How much (if any) you owe towards your annual deductible

• Your copay and/or coinsurance for outpatient mental health office visits

• The number of outpatient mental health visits you have covered annually