Initial Visit Forms - Adult, Couples, or Family

Please print ALL PDF documents, fill out to the best of your ability and sign the forms.

  • PLEASE DO NOT SIGN THE FORMS IF YOUR SESSIONS ARE BY VIDEO CONFERENCING. We must witness you signing the forms over video.

  • If you are coming in for Couples or Family counseling, please Fill out two sets of forms and all parties sign where appropriate.

Adult, Couples and Family Intake Form

Counseling Agreement 

Technology-assisted Services Informed Consent Addendum

Hipaa Act Information

Adult Checklist

Release Information

Credit Card Authorization

Initial Visit Forms - Child/Adolescent

Please print ALL PDF documents in the file, fill out to the best of your ability and sign each form where appropriate.

  • If you have multiple children scheduled for counseling sessions, please fill out a separate packet for each child.

Child Adolescent Intake

Counseling Agreement 

Technology-assisted Services Informed Consent Addendum

Hipaa Act Information

Child/Adolescent Checklist

Release Information

Credit Card Authorization

The Vine Wellness Group

14802 Jones Maltsberger Rd #1101, San Antonio, TX 78247, USA

17080 HWY 46 #109 Spring Branch, TX 78070, USA

help@thevinewellness.com

(210) 490-4419

©2020 by The Vine Wellness Group