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Your Visit
Consent Forms
Registration & First Visit
Registration is required for all services we offer. We recommend that you call ahead to schedule an appointment and have a valid identification, a copy of your insurance card(s), and, if necessary, any documents from your previous treatment(s) with you during your first visit. We also recommend that you arrive at least 30 minutes prior to your appointment to complete the paperwork and have a list of any medications you may be taking.
New Patient Forms
Patient Registration Form (Intake Packet)
Patient Psychiatry History
Patient Health History
Existing Patients
Patient Portal
Medical Records Release Form (Records for Wilmington Mental Health)
Medical Records Request Form (Records From Third Party)
Credit Card Authorization Form
Note: All Professional Disclosure Statements for your counselor can be found on their profile here.
Security & Privacy
All of our forms are encrypted to protect the safety of our patient’s information. The security and privacy of our personal data is our main concern and we take every precaution to protect it.
We like to identify our patients and obtain core data that helps us better understand their situation. This information not only helps our providers design a treatment that fits their patient’s needs, but also protects our patients from fraud.
Completing Your Forms
To save time, we ask our patients to complete our intake packet online or download the printable version and bring it with them to their first appointment. When completing the form online, please fill out all necessary fields and do not forget to click submit at the end. The form will automatically be sent to us.
If you choose to send us a hard copy of the registration form by mail, please attach a copy of your identification and insurance card (front and back). If any information about you changes during your treatment, please let us know.
Note: We ask to verify your contact information and insurance coverage every visit to ensure that your information is up-to-date.