Forms Center
L.A.'s Wellness Solutions looks forward to designing an individualized
wellness plan customized specifically for you. Below are required forms you
will be instructed to use based on the services chosen for your personal plan.
Again, contact us via phone or email with any questions.
Please fax your 'New Client Information' sheet 24 hrs prior to your first appointment (or mail/deliver it 48 hrs prior). Co-payments may be made via cash or check. There is a $25 new client set-up fee due the first session along with your co-payment.
L.A.'s Forms Required of All Services:
Fax the first two (2) forms to secure fax 281-974-2827 to initiate benefits ck and initiate an
appointment. If your M.D. or Employer has given you a complimentary inquiry card, follow
those directions to initiate services.
1) Referral Form*: M.D., Professional, or Self
*Please see referral form located on this page:
"Contact Us". NOTE: Even as a SELF-referral,
L.A.'s Wellness Solutions appreciates & requires you submit a self-referral form. Often you do
know yourself better than others & this self-knowledge is valued & appreciated.
2)
* If filling out child checklist, please fill out ADULT form as well providing a 'snapshot' of the child's family system environment
L.A.'s Counseling Center Forms:
L.A.'s WellBeing Center Forms:
Biofeedback Forms for Counseling or Training:
