AWMLogo_websmall

numbers

spacer

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:

  • Step 1: Complete an Intake packet for your state of residence.  The links below will present a PDF file which you can download and fill out by hand.

                    Arizona Intake Packet              Colorado Intake Packet

  • Step 2: We will work with your insurance provider to determine the insurance benefits of which you may be entitled.
  • Step 3 (Dependent on your specific insurance provider): 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.
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.