Pathways Telehealth Clinic and Wellness Program Forms:
Please complete the 3 forms (Adult or Child & Adolescent demographic, Informed Consent, and HIPAA & Privacy Act) in order to become a new patient of Pathways MHS Telehealth or Pathways Wellness Program
We cannot process your intake paperwork until we received all of the required forms and a copy of your insurance card and picture ID. You need to put your SIGNATURE on all of the required fillable forms.
After completing the fillable forms, please fax a copy of your photo ID and insurance card to (360) 846-1722 for the Telehealth Clinic. Once we have all forms and have verified your insurance coverage, we will call you to schedule an initial assessment.
We cannot process your intake paperwork until we received all of the required forms and a copy of your insurance card and picture ID. You need to put your SIGNATURE on all of the required fillable forms.
After completing the fillable forms, please fax a copy of your photo ID and insurance card to (360) 846-1722 for the Telehealth Clinic. Once we have all forms and have verified your insurance coverage, we will call you to schedule an initial assessment.
Notice: Due to Washington health care laws, the ROI form should be completed by clients age 13 and up if a parent or other party will need to communicate with us about scheduling or other information.
