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NEW & EXISTING CLIENT FORMS

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Wellness Grove digital forms are fully HIPAA-compliant, secure, and provide an intuitive and dynamic experience. Should you require assistance with any of the forms, please reach out to Wellness Grove for assistance.

CLIENT ONBOARDING

As part of the client onboarding process into Wellness Grove, there are a few forms that are required to be completed before your first scheduled appointment.

Please complete one of the client intake forms that represents the age of the client: (choose only one)


Client Intake (Adult)

Client Intake (Adolescent, Age 13-17)

Client Intake (Child, Age 12 & Under)

All forms here are required: (4 total)


Client Registration

Informed Consent

Telemental Health Consent

Notice of Privacy Practices (NPP)

Optionally, for self pay/copay insurance members:


Automatic Payment Authorization

Optionally, if the client is transferring from another provider/organization, please choose and complete one of the following forms: (choose only one)


If the client is NOT represented by a parent, guardian, or personal representative:


Release of Information

If the client is represented by a parent, guardian, or personal representative:


Release of Information (On Behalf of Client/Minor)

SELF-REPORT MEASURES

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