Wellspring Counseling
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Client Forms

Find the appropriate paperwork your counselor or coach instructed you to obtain and download it by clicking on the item below. We hope you find your experience at WellSpring convenient and helpful.

  1. Instructions for First Visit
  2. Client Information Form
  3. Personal Information Questionaire - Adults
  4. Disclosure and Consent Form
  5. Welcome and Clients Rights
  6. WellSpring Notice of Privacy Practices
  7. Questions to Ask Your Insurance Company
  8. Questions to Ask Your EAP.pdf”
  9. Marital Self Report
  10. Pre-marital Self Report
  11. Child/Adolescent Report
  12. Parent Report for Dependent Child
  13. Family of Origin Form
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Clinician Spotlight

Yero N'diaye, Intern

Yero earned his Bachelor’s degree in Psychology from The Ohio State University and is currently pursuing his Master’s in Social Work at Ohio State. He has a strong background in research, serving as a research assistant on several studies focused on psychology and sociology, including The Ohio Study: Adolescent Health and Development in Context and the SOAR Wellness Discovery Survey.He is passionate about exploring how environmental factors influence mental health and is particularly focused on addressing mental health disparities affecting communities of color. Yero hopes to integrate his academic research experience with his clinical work to provide holistic, culturally informed support to clients.Outside of his professional and academic work, Yero enjoys writing and recording music, singing, and playing guitar. He also finds peace in nature and loves fishing with friends. One of his goals is to catch a 50-pound catfish.

He has availability on Monday, Wednesday, and Fridays.

Request A Session
Wellspring Counseling
  • Rivers Edge Corporate Center
    Building A, Suite 100
    1335 Dublin Rd.
    Columbus, OH 43215
    614-538-0353
Questions?Click here for answers!
Billing questions? Call 614-538-0353 ext. 6201

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  • A Central Ohio Youth for Christ Ministry