Client Forms & Portal

Welcome new clients. Thank you for choosing Wynns Family Psychology. We look forward to helping you and your family. Login to your WFP Portal here if you already have an account.

Before scheduling your first appointment, we will send new client forms for you to fill out and sign. Below is a list of forms you can expect to recieve based on your service category. We will discuss these completed documents during your first visit and will be happy to answer any questions at that time. Please keep a copy of your forms, as they are important informational documents.

To receive your documents, please call our office at 919-467-7777 or email info@WynnsFamilyPsychology.com regarding your services.

Good Faith Estimates

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 919-467-7777.

Therapy Services Forms You May Receive

• Therapist-Client Mental Health Services Agreement—
  Discusses information concerning the practice, financial arrangements, confidentiality, and patients’ rights
• Intake Form—
  provides contact and insurance provider information
• Child Background Form—
  For children 17 and below
• HIPAA North Carolina Notice—
  Explains the policies and practices used to protect the privacy of your health information
• Therapy FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Therapy Services

Testing Services Forms You May Receive

• Evaluation & Testing Services Form—
  For psychoeducational or psychological evaluations
• Early Entry to Kindergarten Background—
  Only for early entrance to kindergarten testing
• Therapist-Client Mental Health Services Agreement—
  Discusses information concerning the practice, financial arrangements, confidentiality, and patients’ rights
• Intake Form—
  provides contact and insurance provider information
• Child Background Form—
  For children 17 and below
• HIPAA North Carolina Notice—
  Explains the policies and practices used to protect the privacy of your health information
• Testing FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Testing Services

Group & Camp Services Forms You May Receive

• Social Skills Group & Camp Registration Form—
  For participants of social skills, study skills, etc
• Therapist-Client Mental Health Services Agreement—
  Discusses information concerning the practice, financial arrangements, confidentiality, and patients’ rights
• Intake Form—
  provides contact and insurance provider information
• HIPAA North Carolina Notice—
  Explains the policies and practices used to protect the privacy of your health information
• Social Skills FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Social Skills Services

DBT Group Services Forms You May Receive

• DBT Group Registration Form—
  For participants of Dialetical Behavior Therapy Groups
• Therapist-Client Mental Health Services Agreement—
  Discusses information concerning the practice, financial arrangements, confidentiality, and patients’ rights
• Intake Form—
  provides contact and insurance provider information
• HIPAA North Carolina Notice—
  Explains the policies and practices used to protect
  the privacy of your health information
• Dialectical Behavior Therapy FAQ's—
  Frequently Asked Questions about Wynns Family Psychology DBT Services

Child Custody Services Forms You May Receive

• Child Custody Services Form—
  For child custody or parenting plan consultations
• Intake Form—
  provides contact and insurance provider information
• HIPAA North Carolina Notice—
  Explains the policies and practices used to protect the privacy of your health information
• Consent to Communicate with WFP—
  Discusses the methods by which you and Wynns Family Psychology may communicate
• Child Custody FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Child Custody Services

Additional Forms You May Receive

• Consent to Release Patient Info—
  If you want us to communicate with another care provider or professional, such as your medical doctor, prior therapist, or psychiatrist
• Credit Card Payment Consent Form—
  If you want us to keep your credit card on file to use for ongoing payments
• Reunification Therapy Agreement—
  For families seeking reunification therapy, to be filled out in addition to all standard therapy forms
• Telehealth Agreement—
  For online therapy services

Additional Resources You May Receive

• Early Entry to Kindergarten Information—
  Considerations, test prep suggestions, online resources, WCPSS requirements, what to expect with Kindergarten Readiness Testing
• Mental Health Insurance Benefits "Cheat Sheet"—
  A quick guide for finding out about your mental health insurance benefits
• Reduced-Fee Application—
  For clients with a financial need
• Therapy FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Therapy Services
• Testing FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Testing Services
• Social Skills FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Social Skills Services
• Dialectical Behavior Therapy FAQ's—
  Frequently Asked Questions about Wynns Family Psychology DBT Services
• Child Custody FAQ's—
  Frequently Asked Questions about Wynns Family Psychology Child Custody Services
• Workshop Registration Form—
  For No Wimpy Parenting & Other Workshops