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 You are Here:- Staff & Services>Counseling / Coaching>Client Forms July, 02, 2009  

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Client Forms Minimize
New Clients:  You will find some of the various intake paperwork you will need to get started for your counseling / coaching experience.  Select the documents your counselor or coach instructed you to download.  Click the download button and save the file to your computer.  Fill out the appropriate paperwork and bring it with you for your initial visit. 

Active Clients:  Find the appropriate paperwork your counselor or coach instructed you to obtain and donwload it as per the instructions above.

We hope you find your experience at WellSpring convenient and helpful!
  
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 TitleCategoryDescriptionSize (Kb) 
1. Client Rights and WelcomeNew Client FormsThis document tells you about WellSpring and your rights as a client.159.74Download
2. Client Information FormNew Client FormsThis document provides personal, insurance and billing information.631.39Download
3. HIPAA Privacy NoticeNew Client FormsThis document describes how private health information about you may be used and disclosed and how you can get access to this information.359.92Download
4. HIPAA Privacy AcknowledgmentNew Client FormsThis document serves to provide receipt for acknowledgment of receiving WellSpring's privacy practices.610.46Download
5. Questions to Ask Your Insurance CompanyNew Client FormsThis document will help you when you call your insurance company to inquire about Mental Health/Behavioral Health benefits. 591.79Download
6. Questions to Ask Your EAP CompanyNew Client FormsThis document will help you when you call your EAP Company to inquire about Mental Health/Behavioral Health benefits. 590.24Download
7. Clinical History ReportNew Client FormsThis document is designed to gather information about you and your health.679.25Download
8. Self Report (Marital)New Client FormsThis document is designed to gather information about you, your health, and your marriage. (Marital)36.34Download
9. Self Report (Pre-Marital)New Client FormsThis document is designed to gather information about you, your health, and your pending marriage. (Pre-Marital)38.50Download
10. Self Report (Child / Adolescent)New Client FormsThis document is intended to gather information about your health. (Child / Adolescent)39.87Download
11. Authorization for Release of InformationActive Client FormsThis document authorizes your counselor to speak to and share information with another professional or individual related to your needs, and releases them to do the same.618.01Download
12. Personal Safety AgreementActive Client FormsIn case of any threat of harm to self or others, this document is an agreement to call for help before any destructive action is taken. It provides resources to call on in case of emergency.622.20Download

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