We provide access to online payments through Venmo for your convenience. You must sign and return the provided "Venmo Payment Disclosure" form below To Wellspring Behavioral Health prior to conducting any bill payments through Venmo.
This disclosure is to notify you that you may utilize Venmo to make payments on your Wellspring Behavioral Health account. Depending on your account settings, some of your transactions with Wellspring Behavioral Health may be viewable to your contacts. The privacy setting that Wellspring Behavioral Health uses is private, however, if your setting is not private, some transactions may be seen by others. By signing the document provided below, you are releasing Wellspring Behavioral Health of any liability or breach of privacy. Wellspring Behavioral Health will continue to protect your private health information in accordance with HIPPA. You have the right to not utilize Venmo at any time and make payments in person via, credit card, check, and cash. Confirmation of your Venmo payment will be printed and put into your file. Wellspring Behavioral Health reserves the right to stop utilizing Venmo at any time. You will be contacted if Wellspring Behavioral Health stops accepting Venmo as a form of payment.
If you are interested in receiving your monthly balance via a Venmo request, please initial in the indicated area in the document provided below. These requests will happen on or around the 1st of the month. If you choose to receive your monthly balance notification via Venmo, Wellspring Behavioral Health will NOT send you a monthly statement. Statements will be available by request.
Venmo Payment Disclosure
Provides access to online payments through Venmo for your convenience