Intake Forms & Screening

Intake Forms  |  Screening Tools  |  What to Expect at Your Intake Appointment

Intake Forms

Please download and print the Intake Packet for your age. Bring completed forms to your intake session.

You may also have the forms emailed to you by entering your name and email address below.

Your Name *

Your Email *

SOUL FOOD INTAKE PACKET
(WEIGHT MANAGEMENT GROUP)

Completed forms at your initial session will save time and is a requirement before treatment can begin.

Thank You!

Screening Tools

If you think you are suffering from any of the following categories, please print and fill out the attached screen. The more information we gather, the more comprehensive approach your provider can take in diagnosis and tailoring your treatment. These tools will save time and money if completed and brought in to your intake session. Thank You!

SUBSTANCE ABUSE

Use these free screening tools to help determine if you or a loved one may have a drug or alcohol problem. These tools are not intended to diagnose but they will help determine if there is need for a formal assessment.

OBSESSIVE COMPULSIVE DISORDER Y-BOCS

EATING DISORDER EAT-26

SOCIAL ANXIETY Liebowitz Social Anxiety Scale

ADULT ADHD ASRSv1.1

ANXIETY Hamilton Anxiety Scale (HAM-A)

DEPRESSION Zung Depression Scale

What to Expect at Your Intake Appointment

Dear Valued Client,

A few notes from the director to help you prepare for your first appointment.  Our website has all of the forms you need but if you have not printed and completed your intake paperwork (above), you will need to do that before your first appointment, so arrive 20 minutes before your scheduled appointment time to allow for completion of this information.

You will also be required to complete a payment agreement which includes information we collected from your insurance company regarding co-pays, co-insurance and deductibles. It also includes our policies on payments, checks and appointment cancellations.

We do require a credit card number to be kept on file as a guarantee of payment if our efforts to bill you and/or your insurance have not been productive. 

We check your benefits before your first appointment.  We make you aware if your insurance company is not paying a claim.  We give you the option of calling your insurance if our repeated efforts are not successful.  Ultimately, you are responsible for an unpaid claim plus co-insurance or co-pays.  We reserve the right to bill your credit card when you have not responded to our normal billing cycle.  Your credit card information is encrypted.  If you foresee a problem with providing this information, please ask to speak to the director our the billing specialist.

Once your therapist takes you into your first appointment, the paperwork will be reviewed and discussed and the clinical interview will begin.  The interview may take several sessions to complete and includes questions covering many domains that helps us help you!  It may feel a little frustrating to talk about so many other things when you may be here to focus on one thing in particular but if you are patient with the process, we can see the issues more clearly and not waste time by jumping into helping too quickly.

A final piece of the assessment process is a paper and pencil test that helps us understand your personality better and develop treatment plans and interventions suited to you.  The test is scheduled after your intake appointment and your therapist does not need to be present.  One of our staff psychologists will meet with you and your therapist at a later date to go over the personality assessment.

Thank you for your cooperation in all of these matters,

Dr. Beth Johnson

Executive Director

Contact Us

Lakefront Wellness Center, S.C.

Phone: 262-695-8857
Fax: 262-695-8879

lakefrontwellnesscenter@outlook.com

Hours

REGULAR BUSINESS HOURS:
Monday through Thursday
9am to 5pm

Evenings, Friday and Saturday:
Limited availability of some Therapists, call for more information
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