Below are the forms you will need to apply for therapeutic services. Complete screening packets will be screened in the order they are received. The person filling in the forms will be contacted after screening is complete. For further questions you can reach us at 608-421-3239.
Therapy Privacy Practices Notice, Grievance Procedure, Important Policies to Be Aware of, Access to Records
Pre-Intake Screening Form and Insurance Information, Payment Contract for Services Form. Please also provide a full medication list (no form provided, submit using whatever format you have available)
Signed Informed Consent, Signed Financial Policies
Please submit your screening packet using one of the following methods:
1191 N Sherman Ave
Madison, WI 53704