Thank you for your interest in A WiserMind services.
Our Brain Activation Therapy and Emotional Wellness Therapies are types of mental health services. This means that we need to collect some information about you and you need to know your rights as it relates to our services and your health records.
To accomplish this, we have an intake process which allows us to:
- Get your permission to talk to your medical provider so that we can make sure our services are coordinated with your doctor’s care plan.
- Understand what insurance benefits you might be entitled to which may cover some or all of your expenses.
- Explain your rights related to your privacy, your personal care and the health records that we may create on your behalf.
The steps of our intake process are:
- Completion of our New Client Intake Packet by you or someone who is authorized to complete the packet on your behalf.
- Investigation and confirmation of insurance benefits of which you may be entitled.
- Collection of health information from your primary doctor to understand the current health situation and gather diagnosis information which may be required by available insurance providers.
The Intake Packets are available in two formats. You can complete this form online, or you can download a PDF version of the packet to fill out by hand.
Before you start completing the forms will be helpful to have the following information available:
- Client’s primary insurance information including: identification numbers, Plan ID or group numbers (if any), phone number and mailing address.
- Client’s supplemental (secondary) insurance information including: identification numbers, Plan ID or group numbers (if any), phone number and mailing address.
- Client’s physical address and date of birth.
- Client’s primary doctor’ and any secondary (specialists) providers along with phone number and fax if available.
- Name and contact information for the responsible party (medical and financial power of attorney) if different from the client.
