New Client Information Form

Welcome to Accord Health & Wellness Services. We’re glad you’re here.

This quick form helps us gather your basic information so we can begin your onboarding process and connect you with the right provider or service. Once submitted, our team will review your details and guide you through the full intake process.

For a faster pre‑onboarding process, please provide your insurance information.

Click the link below to submit your insurance details for quick verification.

Insurance Submission Form

Required Documentation

Identity Verification

Insurance Details

Supporting Info

To protect your health records, we will require a valid government-issued photo ID (driver's license, state ID, or passport) to confirm your identity.

We will need your current insurance information: the insurance name, policy number, and group details so we can verify your mental health benefits prior to your session.

We may request any supporting additional information, such as referral letters, medical history, or clinical notes, to help us tailor your treatment.

Next Step

To finalize your onboarding, our staff will contact you to request your insurance card, ID, and any supporting documents for secure and accurate processing.

FAQs

Is my data safe?

Yes, all information is protected with HIPAA-compliant security measures.

What details are needed?
Can I upload documents?
Who can refer me?

Our clinical staff will contact you directly to request any necessary items, such as your insurance card, ID, or supporting records, and provide instructions for secure submission.

We ask for personal information, insurance information, medical information, and appointment reasons.

Referrals can come from doctors, therapists, or trusted community members.