Forms
In order to start our Therapy Sessions, we need you to complete and sign the following Intake Forms
Thank you for trusting us as your Mental Health Providers
In order to start our Therapy Sessions, we need you to complete and sign the following Intake Forms:
1. Consent Form Mary Joseth Miranda Tourino
2. WBC Health Insurance Information and Consent
3. WBC HIPPA Consent
4. WBC Intake Pt Consent
5. WBC Psych Agreement
6. WBC Release of Information
7. WBC Cancellation and No-Show Policy
8. WBC Client Scheduling
9. WBC Credit Card Authorization – for copays or self cash
We also need:
10. A photo of Client’s ID. (Front / Back).
11. A photo of Client’s Insurance Card. (Front / Back).
And:
Getting Started is Easy
Call or Email
Give me a call or send me an email, I will get back to you quickly.
Book Appointment
Let’s set-up a day that’s best for you.
1st Session!
Can’t wait to meet you and see what I can do for you.
