Forms

INTAKE FORMS (Make sure that you bring all of your completed forms with you on your initial visit):

If you would like to complete your new client forms prior to your initial appointment, this will save you some time of completing these forms in the waiting room.

Please click the links below to print the appropriate forms. Each client will download 3 files. Select between forms for adult clients and minor clients. Be sure to bring these forms 

Adult Clients (18 years old and older)

Explanation of Services and Privacy Practices

Adult Intake Form

Adult Forms Packet

 

Minor Clients (younger than 18 years old)

Explanation of Services and Privacy Practices

Minor Intake Form

Minor Forms Packet

 

Authorization to Disclose Protected Health Information- HIPAA Release

If you would like for WTCG to share information about your treatment or condition, or if you would like another provider to share information about your treatment or condition with WTCG, you may use this form to authorize the release of the information you choose.

Referral Form

If you would like to refer a client, you may use the Referral Form and fax to 325-653-4218.