New Client Intake Forms – ALL CLIENTS
Mending Health Care intake forms and all the forms below must be completed by the new clients.
Consent for Services – ALL CLIENTS
This online form contains an agreement to begin services. This form requires a signature.
Fee Schedule – ALL CLIENTS
This form is a fee schedule agreement for both insurance and cash accounts. This form requires a signature.
Teletherapy Consent Form – TELETHERAPY CLIENTS ONLY
A HIPAA-compliant online form that authorizes the use of Teletherapy /medicine in the services that you receive. This form must be used to satisfy federal and state requirements.
Cardiac Risk Questionnaire – MEDICATION CLIENTS ONLY
Online questionnaire requesting patients’ history of any cardiac problems. This questionnaire is used for those patients seeking medication as part of their treatment.
Release of Confidential Information – AS NEEDED
A HIPAA-compliant form that authorizes the release of your confidential information to a specific person, for a specific reason, for a specific length of time.