Front Office Intake Forms
A great way to save you some time and money is to complete the Life-Style Assessment form. This gives your WPS Counselor a great foundation of information so you can hit the ground running from the very first session. It may look similar to the Personal History Questionnaire to you - but the questions reveal other information to help your treatment. Your WPS Counselor may ask you to complete both this assessment and the Personal History Questionnaire.
PERSONAL HISTORY QUESTIONNAIRE
Help yourself and your WPS Counselor save you some time and money by immediately identifying some of the problems with which you are seeking assistance. Similar at first glance to the Life-Style Assessment, this form asks questions of a different nature. Your WPS Counselor may ask you to complete both this form and the
INFORMATION RELEASE FORM
This form is used to identify another organization and/or person(s) for information and to give them permission to release it to Wicks Psychological Services for the treatment of the client.
Complete these forms only as instructed by the Front Office or your Counselor
CLIENT INFORMATION FORM
This is for new adult clients to be filled out by the client or the client's spouse / sponsor. This also includes information release, insurance authorization and office policy acknowledgement.