PATIENT CENTER
Patient Forms
NEW PATIENTS
Welcome to Free State Health & Wellness. We are looking forward to providing you with mental health services. Please download the New Patient Packet below, fill it out, and send back via email or fax. Or if you prefer, you can print, fill out with pen, upload, and send back via email or fax. The packet must be returned prior to your scheduled appointment, or your appointment will be canceled.
Important: In order to fill out this PDF, download it to your computer, fill it out, and save it using Adobe Acrobat Reader. You will not be able to save the document if filled out in a browser window. If you do not have Acrobat Reader you can download it here for free.
EXISTING PATIENTS
Please download and fill out any of the forms below that have been requested of you, and send back via email or fax. Or if you prefer, you can print, fill out with pen, upload, and send back via email or fax. The forms must be returned prior to your scheduled appointment, or your appointment will be canceled.
Important: In order to fill out this PDF, download it to your computer, fill it out, and save it using Adobe Acrobat Reader. You will not be able to save the document if filled out in a browser window. If you do not have Acrobat Reader you can download it here for free.