Forms

Thank you for choosing The Wellness Centre as your service provider.  We are committed to providing you with the highest quality of care.

Here you will find a selection of forms that you can download and deliver to us at info@wellnesscentre.ky or deliver to us by hand.

Individual Adult Intake Form

Client Financial Responsibility Agreement

Client Guarantor Credit Card Pre-Authorization

Health Insurance Claim Form

Adult Release of Information

Child and Adolescent Intake Questionnaire

Informed Consent of a Minor

Consent for Exchange of Information for Minors