0063993760
The Bridge To Wellness
♦ Client Forms

Schedule Appointment

 

Please complete the Initial Intake form online and send.

It will automatically be emailed to our office and your information will be uploaded into our systems. 

Initial Intake form

 

Please print, complete and bring the following paperwork to our office.

  • Consent for Treatment
  • HIPAA Signed Consent
  • Body Map for Clients, if needed

We will request them prior to your inital visit.

 

Consent for Treatment form

HIPAA Signed Consent

HIPAA Privacy Practices Informational Only

Body Map for Clients

 

 

Other forms that may be requested by your therapist:

Screening Questionnaire form

Health Status Update form

Physician's Permission form

Physician's Referral form

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