New GJB Health Services clients must fill out the New Client form:
Step 1: Open the New Client form by clicking on the button below.
Step 2: Save the form on your computer so that you can fill it out. You may also print the blank form and fill it out by hand.
Step 3: Print the form (either blank or filled out)
Step 4: Bring the completed form in with you to your first appointment*
*Please do not email the completed forms back to GJB Health Services. Our email is not encrypted, and we cannot ensure your privacy. You may fax the form to (920) 560-6618 or simply bring it to your first appointment
New Patient Form
Should clients wish for your new provider to communicate with any previous provider(s), please print, complete, and sign the Release of Protected Health Information form below:
Click the button below to view and print the DSM-5 form:
Problems with these forms?
Of course we do understand that there are some very good reasons why you might not feel comfortable working with the online form. If that is the case, we will absolutely do whatever we need to do to help you find a solution. We can walk you through it over the phone or mail you the questionnaire. You can even stop by and pick one up; that way you will know right where our office is located and how long it will take to get to us.
Just call us at 920-560-4525, or E-mail us firstname.lastname@example.org with any problems, concerns or questions. If necessary, we can also go through the information during your initial visit; don’t stress about it, we want to help you decrease your stress level-not add to it.
Thank you so much!
Once you arrive at our office for your initial appointment…
You will be greeted by our receptionist. If you have the forms (from the link at the top of this page) printed and filled out completely, you will give them to the receptionist. If you have not printed, filled out and/or brought them with you, you will need to fill them out before you are seen by the therapist. Please plan to arrive at least a half hour prior to your first appointment to allow ample time to complete this paper work. Please bring your insurance card along so that we can copy that as well. If you have any questions give us a call. We are looking forward to meeting you!
You will be greeted by our receptionist and will be asked to complete some paperwork. This paper work typically takes 5-1O minutes of your time, so you can plan accordingly.
Please bring your insurance card along so that we can copy that as well.