Visit us Mon-Fri from 9:00am to 7:30pm
 3825 Market St, Suite 4

Important Documents

Intake Form
Get Started

We use registration forms to obtain core data and identify our patients. These forms will help us better understand your situation and design a treatment that fits your needs. To save time when you arrive for your first appointment, please download and complete our intake packet. Please print it and bring it with you to your first visit. If any information changes during your treatment, please let us know.
Email/Texting Consent
We keep your Protected Health Information private and secure. This consent form is to gain permission to share administrative information like appointment reminders, scheduling, or payment receipts with you. Please understand that some potential risks associated with email/text interaction include: misdelivery, unauthorized access to thirdpartes, information may remain in the cloud. Please indicate your preferences about emails and texts and sign this form.
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Release of Information
This form is to give us permission to communicate with third parties. The content and information to be released is protected under State and Federal law (45 CFR Part 164 and 164; 42 CFR Part 2) and cannot be re-disclosed without further written consent as authorized by G.S. 122C-53 through G.S. 122C-56. A general authorization for the release of other medical information is not sufficient for this purpose. More details can be found in our Privacy Practice form.
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Payment Authorization

We ask you to provide formal authorization to process credit card payments. Please verify and complete this form to give Wilmington Mental Health to do so. Do not omit any fields and include your signature and today’s date at the end.

A picture ID (school ID, military ID, etc.) is required for all patients 18-year-old and older to protect you and our practice against insurance fraud.


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HOMEWORK ASSINGMENTS
Therapy Worksheets

Homework is an element of therapy that makes it collaboratively and allow patients to rehearse skills learned during treatment. Our therapists assign tasks to be completed between sessions to:

Facilitate processing • Develop awareness • Promote active change • Consolidate learned knowledge • Foster long-lasting outcomes.