NEW CLIENTS: ONLY submit the “1. Client Information” - our team will reach out to you for what forms to fill out next.
START HERE:
new client intake forms
Please Note: we are currently experiencing a high demand for our services. Please be patient with us until we are able to get back to you. We will contact you within 2-4 days from the date you submit forms to begin the scheduling process. Please complete the first form only to start the process of getting scheduled. One of our Intake Coordinators will reach out to you with further instructions, We consider all location and therapist requests but may need to recommend other therapists at other locations if your requested therapist(s) is/are not available. Thank you for your understanding.
Only fill out the FIRST form - the others will depend on your service needs.
Here are some helpful hints to make this process go smoothly:
1. Provide information for all of your health insurance(s) - front and back of the card. We need both your primary health insurance and your secondary health insurance cards, if you have them. Please provide the name, date of birth, address, and the relationship to you of the person who is the primary subscriber on the health insurance plan.
2. Before completing our online forms, contact your health insurance company and ask them about your benefits. What is your copay? Does your medical deductible need to be met before your insurance will help pay for services? Depending on your coverage, having to meet a deductible first can mean a difference of a $25-30.00/copay or $85.15-125.00/copay cost.
3. Couples Therapy Sessions are private pay only; we are not able to accept insurances for couples at this time.
4. We see clients aged 16 and up. If you have a child aged 12 - 15, we will consider placement after speaking with you further regarding your child's needs; do not fill out any paperwork until you have spoken to us. We have a very limited number of staff who are able to work with ages younger than 16. Please note: we are not a crisis center. We do not provide IOP or PHP services. If your child is in need of immediate help, please reach out to Nationwide Children's Hospital, Buckeye Ranch, Directions for Youth, Concord Counseling, or NYAP: National Youth Advocate Program.
5. We are no longer accepting the following insurances: Molina, Beacon Health Options, UBH Medicare, or Ohio PPO.
6. Please note: secondary insurances do not always automatically pay their part when we bill them. If a secondary insurance does not pay, the client is responsible for the remaining copay amount.
7. We don't do psychological assessments, ADHD assessments/evaluations/testing, court-ordered evaluations/treatment, or alcohol and/or drug assessments. We only provide mental health assessments and treatment.
8. We are currently not accepting Anthem EAP clients. We have very limited availability for placing EAP clients. The more flexibility you have in your schedule helps. Using health insurance instead of an EAP plan can help, as we have a limited number of EAP providers. Please ensure that we receive EAP authorization prior to completing our Intake paperwork.
9. The majority of our available sessions are between 9am and 3pm. Being flexible with your schedule can help with getting an appointment sooner. Most therapists' evening sessions are booked for several months, but cancellations can open up a time slot.
10. If you schedule an appointment and do not cancel more than 24hrs in advance, you will be charged a $50 Missed Appointment Fee. You will not be rescheduled for future sessions until that fee is paid. Please be considerate of our therapist's schedules and the need of other clients who are waiting for a time slot to open up with their therapist, by canceling any appointments with more than 24 hours notice.
Thank you for your patience and understanding.
In order to start working with a Serenity therapist and schedule a therapy session,the first form listed below must be filled out and submitted. Please only complete form 1. When we receive your submitted information, our Intake Coordinator will contact you to discuss what forms to complete next; then we can start the scheduling process. We will e-mail you a Welcome Packet after your first appointment is scheduled. The Welcome Packet provides further information detailing the services we provide, policies specific to cancellation, communication, confidentiality; client's rights, and information about our compliance with HIPPA.
These forms provide us with the necessary information to meet you and help create an assessment of your current mental health status. Please take your time in completing the forms and answer all questions to the best of your ability. Plan on about 20 minutes to complete all four required documents.