Integrity Counseling LLC
Integrity Counseling LLC
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    • Home
    • About
    • Meet Our Counselors
    • Administrative Staff
    • Contact Us
    • Join Our Team
    • Forms
  • Home
  • About
  • Meet Our Counselors
  • Administrative Staff
  • Contact Us
  • Join Our Team
  • Forms

New Patient Forms

To request an appointment call: (920)-385-1420

New patients must send a copy of their insurance card, and completed and signed paperwork, Before an appointment is scheduled.

ADULT Intake Packet - Printable (pdf)Download
ADULT Intake Packet - Fillable (pdf)Download
MINOR Intake Packet - Printable (pdf)Download
MINOR Intake Packet - Fillable (pdf)Download
Telehealth Consent (pdf)Download
Telehealth Authorization & Payment Policy (pdf)Download

Existing Patient Forms

Updated Paperwork for Existing Patients Before January 2024

Existing Adult Patient Questionnaire (pdf)Download
Existing Minor Questionnaire (pdf)Download
Consent for Treatment (pdf)Download
Billing & Credit Card Authorization (pdf)Download
Telehealth Auth and Payment Policy (pdf)Download
Telehealth Consent (pdf)Download
ROI (Request of Information) (pdf)Download
Referral Form (pdf)Download

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Accepting New Patients

Please Call 920-385-1420