Downloadable Forms
All client forms listed below are in Adobe PDF format and will open in a new browser window when you click on the hyperlink.
The free Adobe Acrobat Reader is available for download at www.adobe.com.
Counseling Services
- Application for Program Assistance
- Client Mental Health Insurance Questionnaire
- Client Registration Form
- Consent for the Release of Information or Records
- Informed Consent
- Notice of Privacy Practices and Acknowledgment Form
- Personal Data Inventory
- Renewal Application for Program Assistance
- Third Party Guarantee of Payment Form
Please print and complete the appropriate forms according to your counselor's instructions and bring them with you to your counseling session or fax them in advance to Wellspring at 636.449.1268.
Wellspring does not currently file insurance claims for clients. However, we are happy to assist you by providing the needed information for requesting pre-certification and/or the documentation needed to file claims for yourself. We have provided the following suggested questions to assist you when contacting your insurance company.
Questions Related to Insurance Benefits
For your convenience, our full-color brochure may be downloaded and printed for your reference.
Group Forms
- Understanding Your Child's Disruptive Behavior Group
- Passage (from Adolescence to Adulthood) Group
Healing Hearts • Restoring Relationships • Liberating Lives