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 (pdf)Download
MINOR INTAKE packet Updated Aug 2024 (pdf)Download
Telehealth Consent (pdf)Download
Telehealth Auth & 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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