Thank you for your interest in Wendy 4 Therapy! Please take a moment to download, complete and print the following New Patient Forms below. These forms are important to me so that I know your complete medical and dental history and can treat you accordingly. Plus, it saves time in our initial consultation.
Please return the following ASAP:
1) Copy of front and back of your insurance card (need immediately to check benefits)
2) Name and DOB of the subscriber AND patient (need immediately to check benefits)
3) New Patient Intake Form with signature (peds or adult)
4) Online questionnaire (peds or adult)
5) If applicable, the “What is hard for you?” quesitonnaires
Please return them via EMAIL (email@example.com) or FAX (630-428-3022.)
Thank you for filling these out prior to your appointment. I look forward to meeting you!
Help me help YOU!