Forms

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Editable PDF Patient Forms

NOTE: In order to fill out the form online you must save the form to your computer. After completion, please email to intake@behavioralwellnessgroup.com or fax to 440-565-2349.

Or, you may also print the forms and bring them to your first appointment, if you are seeing your provider in person. Anyone scheduled for the New Year, 2025, please be sure you are selecting the correct packet.

New Mental Health Patient Forms:

New Mental Health Patient Packet-2024

New Mental Health Patient Packet-2025

Consent to Treat a Minor-2024

Consent to Treat a Minor-2025

HIPPA Notice of Privacy Practices

New Medication Management Patient Forms:

New Medication Management Patient Packet-2024

New Medication Management Patient Packet-2025

Consent to Treat a Minor-2024

Consent to Treat a Minor-2025

Medical Services Request Form

HIPPA Notice of Privacy Practices

 

Insurance Company Questions and Information

Helpful Insurance Information

Questions for Psychological Testing

Questions for IOP Benefits

Other Patient Forms and Information

Suggestions

Client Rights and Responsibilities

Client Grievance Policy

Client Complaint Procedure

Stakeholder Survey

Participant Satisfaction Survey

Complaint Grievance Form

Supervision and Permission to Record