Client Insurance & Forms

We provide access to these forms so our clients can begin with a smooth process. If you have any questions about the forms, please contact us.

Registration Form

Used to give your provider background information about you and also your goals


Intake Form

Includes consent for treatment, and our billing and privacy policies


Healthcare Release

Allows Wellspring access to healthcare info to better serve your needs


Medication Intake Form

Gives your APRN background information about your system health and medication history


Medication Refill Policy

This document needs initialled and signed


Telehealth Consent

Allows Wellspring providers to administer treatment through telehealth communications


We Accept These Insurances

Aetna health insurance logo
Blue Cross Blue Shield health insurance logo
Cigna insurance logo
Medica insurance logo
Medicaid health insurance logo
Meritain Health health insurance logo
Midlands Choice health insurance logo
UMR health insurance logo
United Healthcare insurance logo