Forms and Insurance Information

INDIVIDUAL INTAKE PAPERWORK

If you're filling this out as an individual, please fill out all of the forms below

Client Information - Individual

Informed Consent

HIPAA Policy

Consent for Payment

Text Reminder Consent

Telehealth Consent

COUPLES INTAKE FORMS

In you're filling this out as a couple, please fill out all of the forms below

Partner #1 Intake Form

Partner #2 Intake Form

Informed Consent

HIPAA Policy

Consent for Payment

Text Reminder Consent

Telehealth Consent

ADDITIONAL PAPERWORK

Release of Information

Physicians Referral

Good Faith Estimate

Insurances Accepted

Quartz
Dean
Blue Cross/Blue Shield
Group Health Cooperative (GHC)
Unity
WPS
Medical Assistance/ Badger Care/ Forward Health
WEA
Care Wisconsin
Alliance
CCF (Children Come First)
SISCO
MMSI
MHS/Cenpatico
And other insurances that offer Point of Service Plans

Please call or check with your individual insurance provider for more information.