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Our Forms  (click form to download)


 

Insurance Pre-Screen

The insurance pre-screen can be filled out electronically and emailed back to the therapist. If you plan on using insurance to pay for therapy, we will need to verify your benefits and eligibility prior to the first meeting.

Informed Consent Contract

The informed consent contract covers all of the policies and procedures of Mended Wing Counseling.  Please initial the top of each page and sign on the last page.  You can scan the signed contract and email back to the therapist prior to the first meeting, if it is easier for you.  You may also sign this electronically via Adobe Acrobat, and email this back to your therapist directly.

Release of Information

A release of information will need to be filled out and signed for your insurance company and any other providers, if applicable.  You can scan the signed release and email it back to the therapist, if it is easier for you.

“Blackbird singing in the dead of night Take these broken wings and learn to fly.”  — Paul McCartney & John Lennon 

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