417 W. 81st Avenue #132, Merrillville, IN 46410
info@wellhomepsy.com
219.804.6262 | 260-413-6994
SCHEDULE APPOINTMENT
Services
Patients
For Therapists
Community
For Therapists
About
FAQ
Rates & Insurance
Forms
Contact
Close
Home
Services
Patients
For Therapists
Community
For Therapists
About
FAQ
Contact
Rates & Insurance
Forms
219.804.6262 | 260-413-6994
info@wellhomepsy.com
Forms
Home
If you're a new client, please complete the following forms and bring them to your first session.
↓
HIPAA Notice of Privacy Practice
↓
Insurance Authorization Form
↓
Authorization to Release Information
↓
Physician Referral Form
↓
Client’s Rights and Responsibilities
Request an Appointment
WellHome Psycology,PC © 2021 All Rights Reserved