Thank you for choosing Innovative Health Care Concepts.
This admission packet is comprised of the following sections:
- Patient Demographic Information
- Payment and Insurance Information
- Primary Care Practioner Notice (if applicable)
- Psychological Testing Sections (if applicable)
- Patient Medical Questionaire (if applicable)
- Patient History Questionaire (if applicable)
- Acknowledgement of Terms and Conditions of Service
- Signature and form Submission
- PSC-35 (ages 3-17 only)
- WHODAS 2.0 (if applicable)
- PHQ-9 (ages 12 and older)
- GAD-7 (ages 12 and older)
Which sections you will need to fill out will depend on the services you are seeking. All applicable sections must be completed prior to submission of the packet. If you provide an email address you will receive an email confirmation upon submission, however, for your privacy, none of the information entered will be sent in that email. You may request a copy of your admission packet at your appointment. If after submitting this packet you need to change or correct any of the information submitted, you may do so by following the corresponding link in your submission confirmation email.
We do not recommend filling out this form on a phone. For a better experience please use a desktop, laptop, or large format tablet.
For individuals seeking services that are 14+ years old, it is encouraged that they independently complete as much of the admission packet possible, as appropriate.