Patient
Electronic Forms
All forms are electronic, you may complete on a computer, tablet or smart phone.
NEW PATIENTS
All new patients must complete a "New Patient Packet". This is required prior to your first appointment.
The "New Patient Packet" consists of 3 separate sections:
Once you complete section 1, you will be directed to section 2, and then section 3. Should you close your browser after section 1, you may use the links above to get to the others.
To complete this form you will need:
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Insurance card
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Medication list
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Allow 20-25 minutes to complete all 3 sections
​Established patients who have changed insurance
Any patient who would like to add a family member, friend, therapist, etc to allow verbal communication with our practice/providers.
Grant access to a patients portal account. Gives authorization to send messages on behalf of patient, make/reschedule appointments, view records, etc.
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Obtain records from another entity (clinic, hospital)
OR
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Release records from Raleigh Wellness Behavioral health to another entity (clinic, hospital)
Complete this form to authorize our practice/providers to appeal for medication prior authorizations on your behalf.​