High Level Health & Wellness Center | Orlando, FL 32818
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Printable Forms

New Client Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.
Please fill out the following form:
https://docs.google.com/forms/d/e/1FAIpQLSe5nuiPftCwtD1utZ3YcvCj0X_--rxVFRmpSfjVGNzUQPzFBw/viewform?usp=sf_link

    NEW PATIENT FORM - Personal Data Questionnaire
    Please fill out all questions before we get started

Submit
hlcc_adult_intake_form-new_client__1_.pdf
File Size: 274 kb
File Type: pdf
Download File

hlcc_account_information.pdf
File Size: 49 kb
File Type: pdf
Download File

hlcc_child_intake.pdf
File Size: 149 kb
File Type: pdf
Download File

hlcc_client_agreement_and_therapeutic_policies.pdf
File Size: 167 kb
File Type: pdf
Download File

hlcc_consent_for_treatment_of_a_minor_child.pdf
File Size: 139 kb
File Type: pdf
Download File

Client Intake Form
File Size: 75 kb
File Type: pdf
Download File

Limits of Confidentiality/Cancellations
File Size: 71 kb
File Type: pdf
Download File

Current Client Forms

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Authorization to Disclose
File Size: 2382 kb
File Type: pdf
Download File

Note: To download Adobe Acrobat Reader for free, click here.
Contact Us
High Level
Health & Wellness Center

6399 W Colonial Dr,
Orlando, FL 32818
​

Phone: (407) 668-6025
​
[email protected]​​

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​yahoo.com

Contact Us

High Level Wellness Center
6399 W Colonial Dr,
Orlando, FL 32818
​
Phone: 
(407) 668-6025
​(407-985-2498
  • Home
  • About
    • Philosophy
    • Practitioners Directory
    • Rates
    • Privacy Policy
    • Disclaimer
  • Services
    • BOOSTED TURMERIC
    • 21 DAYS DETOX CHALLENGE
    • Acupuncture
    • Clinical Psychology
    • Exercise
    • Guided Imagery & Relaxation
    • Holistic Nutrition
    • Herbal Remedies
    • Massage Therapy
    • Meditation
    • Reflexology
  • Resources
    • What To Expect
    • Helpful Links
    • Common Questions
    • Helpful Books
    • Blog
  • Book Appointment
  • Contact
    • Connect With Us