New Patient?

Want to become a client of Complete Wellness?  

 

You can call 443-438-7863 or download the CLIENT INFORMATION SHEET form and the INSURANCE ELIGIBILITY BENEFITS form and email back to office@CompleteW.com to get started. 

You can also print the documents, fill them out, and FAX them to 443-957-9485

New clients may refer themselves for one of the many treatment options at Complete Wellness. No outside referral is necessary. 

We can even verify your insurance before your first visit.  Download the forms below

You can fax your completed forms to 443-957-9485 or email them directly to office@CompleteW.com.

Client Information Sheet

This form contains all the demographic information needed to open a client account at Complete Wellness. All new clients must complete this form.

Informed Consent

The informed consent is your contract for treatment. It describes your agreement with Complete Wellness. All clients must sign a contract before receiving services. Please download a copy to keep for yourself.

Insurance Eligibility Benefits

If you are using insurance to pay for all or part of the services you'll be receiving at Complete Wellness, you'll want to download this form, fill in the information that you know, and forward it to Complete Wellness. We'll verify your benefits for you.

Release of Information

Frequently we need prior medical records in order to provide you with the best care. You may also request that your records at Complete Wellness be sent to another provider. Refer to the informed consent above on our policy regarding the release of protected health information.

Review of Systems

If you are seeking medication management services, we need to know a little of your past medical history to make sure you receive the best medication for your symptoms.

Visit

10 West Madison Street #11

Baltimore, MD 21201 

Call

T: 443-438-7863

F: 443-957-9485 

Visit

10 East Baltimore Street Suite 1400

Baltimore, MD 21202 

© 2015-2019 by

Complete Wellness, Inc

All rights reserved

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