Welcome! As a new patient to Arch Psychotherapy & Wellness we would like to save you a little time by allowing you to print and fill out necessary paperwork prior to coming into the office.
The following forms and information are Required for all Patients:
Notice of Privacy Practices (Nothing to Fill Out,But Important to Read and Understand this Notice.)
Download File
Acknowledgement of Receiving Notice of Privacy Practices (Notice is linked above) (Print and Sign)
Download File
Informed Consent & Important Practice Information (Print, Read, and Sign)
Download File
Credit Card Use Agreement
Download File
Client Intake-Information Form
Download File
The following form is required only If you are using Health Insurance:
Insurance Billing Agreement
Download File
The following form is required only If you will be Self Pay/Private Pay:
Justin Hampton, LCSW- Fee Agreement
Download File
Jamie Fickert, PsyD- Fee Agreement
Download File
Opening these forms requires the use of the Adobe Acrobat program, available for free download here: (Click Here)
If you cannot print these forms out or are having any difficulty please do not hesitate to contact us or feel free to complete the paperwork when coming into the office. We look forward to working with you!