If you provide your email address when setting your appointment we can send these forms to you through a secure app and the information you provide will be automatically imported into your client file to save time during your inital session with one of our providers.

New Patient Registration Form
New Patient registration WC4BH.pdf
Adobe Acrobat document [252.7 KB]
Areas of concern checklist
Concern Checklist.pdf
Adobe Acrobat document [222.6 KB]
Therapy Services Agreement
Therapy Contract WC4BH .pdf
Adobe Acrobat document [485.8 KB]
Personal history form
Willoughby Center initial questionnaire.[...]
Adobe Acrobat document [319.4 KB]
Payment Agreement
Payment agreement WC4BH.pdf
Adobe Acrobat document [149.3 KB]
HIPPA Policy
Willoughby Center HIPPA Policy
HIPPA Policy.pdf
Adobe Acrobat document [380.9 KB]
HIPPA Signature Page
Willoughby Center HIPPA Signature document
HIPPA Signature Page .pdf
Adobe Acrobat document [382.6 KB]
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