For New Clients Please fill out these forms at least ONE day before your appointment. 

THERAPY CLIENTS

Clients under 18y/o will receive a different Portal link. Do not use this one here. 

All New Online Clients must create a Client Portal through the button to the left. After you enter your basic information, you will go to the Forms tab and Fill Out/Sign the Consent Forms. You must complete this before your session. 

If you are using Insurance to pay for session, Colorado or Texas clients only, use the Insurance tab in the Portal to enter that information. 

Verify ID Requirement

For ALL Online Clients: We are required by law to verify your identity. Please email a copy of a picture ID that has your name on it. (you can simply take a legible photo of your ID and email it to us.) You may black out any information except Name, Address, and Date of Birth off of the ID if you want. We do not keep hard copies of your ID. We advise you to send the copy through an encrypted email server from your end. You can create a free account with Send Inc to forward any information to our encrypted email. (info@bereplenished.com)

Once you have completed the forms online, the paperwork is automatically sent to our office. You are ready for your appointment. Thank you!

Additional Forms If Required

Credit Card Authorization Form (Only Required when BRC Manually Enters Payment. Normal Payments are taken through our Client Appointment Scheduler and you enter payment information.)

No Harm Contract

RELEASE OF INFORMATION AUTHORIZATION

Client Intake Paperwork