WFP Forms & Billing
If you are visiting us for the first time, the forms below can help us get you in faster! Instead of filling them out in our office when you visit, you can fill out many of our patient registration and intake forms online beforehand. If you need to use any of the other forms you can print them out, fill them in at your convenience, and bring them in with you.
- Child and Adolescent Intake Packet
- Child and Adolescent Testing Supplement Form
- Consent for Mental Health Treatment of Minors
- Child / Adolescent Testing Report Release Form
Medication Management Forms
Rachel Gladstone Forms
- Authorization for the Release of Medical Records and PHI with Rachel Gladstone
- Intake Packet for Educational Consultations with Rachel Gladstone
- New Patient Appointment Request Form
- Authorization for Release of Medical Records and PHI
- Consent for Telehealth Services
- Anthem Verification Release Form
- Current Notice of Privacy Practices (PDF)
No Surprises Act
Please review these documents to be sure of your billing rights and protections under the law.
- Your Rights and Protections Against Surprise Medical Bills
- Good Faith Estimate Availability Notice
If you would like to pay your invoice using our secure online payment portal please click the button below. Have your invoice number and information ready for reference.