817-460-5575

817-460-5575

  • Home
  • About Us
    • Phill Hampton, LCSW
    • Deidre Thompson, LCSW
    • Nichelle Baly, LPC
    • Erynn Nicholson, BS
  • Services
  • Forms
  • Contacts
  • Client Portal
    • New Client Registration
    • Appointment Calendar
    • Client Login
  • More
    • Home
    • About Us
      • Phill Hampton, LCSW
      • Deidre Thompson, LCSW
      • Nichelle Baly, LPC
      • Erynn Nicholson, BS
    • Services
    • Forms
    • Contacts
    • Client Portal
      • New Client Registration
      • Appointment Calendar
      • Client Login
  • Home
  • About Us
    • Phill Hampton, LCSW
    • Deidre Thompson, LCSW
    • Nichelle Baly, LPC
    • Erynn Nicholson, BS
  • Services
  • Forms
  • Contacts
  • Client Portal
    • New Client Registration
    • Appointment Calendar
    • Client Login
Hampton Wellness Center, PLLC

Hampton Wellness Center, PLLC

Hampton Wellness Center, PLLCHampton Wellness Center, PLLC

Accepted Insurance Plans: Medicare * Optum * Cigna * BC BS

Important Client Forms and Documents

Are you a client of Hampton Wellness Center, PLLC? Perhaps you are a legal guardian of someone receiving therapy or coaching? If so, then feel free to browse through this page for client forms and documents.

Please note:

The forms below are ONLY for new clients that are NOT able to access the portal.  Please complete new registration by clicking on the client portal button and select new client registration. All five forms below will be available to you in the portal.  After completing them you will be able to eSign and add them directly to your client record. 

forms

Intake Questionnaire (pdf)

Download

Informed Consent for Psychotherapy (pdf)

Download

Telebehavioral Health Consent Form (pdf)

Download

Notice of Privacy Practices (pdf)

Download

Payment Consent Form Credit-Debit (pdf)

Download

Clients- How to Prepare For Your First Telehealth Session (pdf)

Download
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