Please complete new patient forms provided below within 24 hours of requesting a new patient appointment. It is required to complete a credit card form if you have a commercial (private insurance) OR if you are self-pay to be sent directly to you from our EHR system (SimplePractice/Client Portal Road to Ready Counseling). If you need of assistance completing the forms below, please contact us at firstname.lastname@example.org
There are two options for completing the intake forms for new patients:
1- You can email the forms provided below along with a copy of the FRONT and BACK of your insurance card(s) to email@example.com within 24 hours of scheduling your first appointment. If you have a commercial (private) insurance or are self-pay, you will also be required to complete a credit card form to be sent directly to you from our EHR System (SimplePractice/Client portal Road to Ready Counseling).
2- You can request for intake forms to be emailed directly to you from our EHR system (SimplePractice/Client portal Road to Ready Counseling) by sending an email to firstname.lastname@example.org with the following information: patient's first name, patient's last name, parent/legal guardian name (f the patient is a minor), and phone number.
Please complete the following 7 intake forms that are required for new patients within 24 hours of scheduling your first appointment.
Email the completed forms and a copy of the Front and Back of your Insurance Cards to email@example.com
Please complete the Standard Intake Questionnaire that represents the patient (Adults OR Children): Only One standard questionnaire is required.
Road to Ready Counseling, LLC
Road to Ready Counseling, LLC Locations:
Mechanicsville VA Office: 7465 Old Hickory DR, Suite D, Mechanicsville, VA 23111.
Midlothian VA Office: 1519 Huguenot Road Suite 200, Midlothian, Virginia 23113.
Phone Number: 804-404-8222
Copyright © 2022 Road to Ready Counseling, LLC - All Rights Reserved.