Before your first visit, please submit your insurance info for verification and sign and complete the new client forms. Thank you and we look forward to seeing you at The Wellness Bank.

Your health insurance plan may cover your visits. We can verify your benefits prior to your initial visit so you know your coverage. Please provide the following information:

Insurance Info

Info about insurance
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
    If you chose Child or Spouse above, please enter the Date of Birth of the Primary Subscriber
  • (You can find this number on the back of your insurance card)
  • This field is for validation purposes and should be left unchanged.

Please complete the forms below and bring them with you to your first appointment.

New Client Paperwork Telehealth Consent HIPPA