New Client Forms

Your First Step Toward Renewal

Welcome to Mind Rejuvenation. We are honored to support your wellness journey. To help us understand your needs and provide the most personalized care, we ask that all new clients complete the intake forms before your first session. These forms are simple, confidential, and supportive of your goals.

Whether you are seeking clarity, healing, or renewal, this first step ensures we begin with compassion, insight, and intention.

Once completed, simply bring these forms to your first appointment so we can start your journey with ease.

Before Your First Visit

The Forms You Will Need

Download and complete each form before your first visit. Click any form to open the PDF in a new tab.

Initial Intake FormProvides your basic information so we can get to know you and begin your care with understanding and clarity.HIPAA Authorization FormExplains how your health information may be used and shared, and documents your privacy preferences.Medication Information ListGathers details about your current medications, and those you have tried, to support safe, coordinated treatment.Financial PolicyOutlines our financial guidelines so you know what to expect regarding payments and billing.Appointment PolicyCovers our scheduling, cancellation, and attendance expectations to help ensure smooth, consistent care.Emergency & Crisis PolicyClarifies what steps to take during urgent situations, what qualifies as a crisis, and how to quickly access support when you need it most.Treatment Consent — Med. ManagementProvides key information about medication based treatment and confirms your consent for Medication Management services.Telehealth ConsentExplains how virtual appointments work and outlines your rights and responsibilities when receiving care remotely.

Contact Mind Rejuvenation

Start Your Healing Journey Today

Whether you are ready to book your first visit or simply have questions about our treatments, we are here to help. Fill out our contact form and a member of our team will reach out shortly.

Every step you take toward wellness matters, and we are honored to walk it with you.