Brains Potential Logo

New Clients

Start Forms Here

OR

Download The Forms

Initial Intake Form
Child Intake Form
Adult Intake Form

Information for New Clients

 

Thank you for contacting BRAINS. Please allow adequate time to complete our intake forms to help speed up the check in process. If you do not wish to complete these forms on-line, please arrive at least 30 minutes early for your scheduled appointment. Due to industry requirements, you will be unable to visit with a clinician until these forms are completed.


Please complete the following intake forms after contacting our office. Please do not complete these forms before contacting the office.


READ CAREFULLY PRIOR TO COMPLETING THESE FORMS:

- Required fields/boxes must be completed for form submission

- Allow a minimum of 30 minutes to complete these forms

- Leaving the browser will delete your information, allow time to complete forms   once started

- Use of arrows in your browser will delete your information, make sure to use the   ‘Back’ button on the lower left corner of the forms if you need to go to a previous   page

 

These forms can be submitted the following ways:

  1. Electronically (be sure that you get a successful confirmation)

  2. Printed and mailed to BRAINS, 3351 Eagle Run Dr NE, Ste C, Grand Rapids, MI       49525

  3. Completed and brought with you to your first appointment

OR

The forms are SSL/TSL encrypted and are stored on a secure server after submission.

 

Important information for your initial appointment

Please arrive at least 10 minutes before your scheduled appointment to allow enough time for us to copy your insurance card and have you sign consent forms. If you have not completed the intake forms mentioned above, please arrive 30 minutes prior to your scheduled session.

 

Evaluation/Testing Clients

 

If this initial appointment is for your child please do not bring the child along. This appointment is for parents/guardians only! If you have any records pertaining to the patient please bring those along with you.

 

Therapy and Neurofeedback Clients

 

Please bring the patient to the initial appointment. You may also want to bring any records (previous evaluations, IEPs, medical records, etc.) that you think would be beneficial for your therapist to review.

 

Insurance

 

If you have any questions regarding your insurance benefits and/or coverage please contact your insurance company directly. If you have any questions regarding the intake forms, directions or insurance please feel free to contact our office at (616) 365-8920.

 

Expectations for Clients/Parents

 

Clients are expected to submit payment for all services provided. Co-payments will be collected at the time of service. Clients are also expected to participate in creating treatment goals and monitoring treatment progress. Your clinician will speak with you more and answer any questions during your initial visit.