102 S. Sandusky Ave.
Upper Sandusky, OH 43351

Mon-Thu 8:30am-7pm, Fri to 5pm
Sat & Sun by appointment

419-294-1212 419-294-6336

New Client Paperwork

If you would like to engage in our services, please call our office to schedule an appointment. When your appointment is confirmed, you are welcome to print and fill out the following forms before your visit to our office. You will also need to provide:

The following documents must be read prior to completing the paperwork below as you will be signing to confirm you read and understand the information. If you have any questions about this information, please call our office for support at 419-294-1212 x 0.

WCA policy regarding Social Media

Client Rights, Responsibilities and Information :

WCA HIPAA Notice of Privacy

Please click on the italicized links below to download the forms. You may need to "save as" to your device in order to access the documents. You can then print the forms and complete them to submit at your first appointment. The forms cannot be completed electronically.

Client Info Sheet :If the client is a child, please complete this form with the child's information.

Client Goals for Treatment : Please complete page 2 of this document only.

Informed Consent for Treatment: This is your informed consent for treatment.

Client Self Assessment Form : Parents may complete this form for children who are too young to do so.

Telehealth Consent Form