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Printable Forms: Youth Client Application and Health History |  Adult Client Application and Health History |  Release

Formas imprimibles en español: Uso Del Cliente |  Historia De la Salud Del Adulto |  Historia De la Salud De la Juventud |  Aviso De la Aislamiento

To expedite your first visit (intake), please download and complete the above forms, and bring them with you, along with the following:

• Proof of income for all household family members (if applicable)
• Proof of insurance (if applicable)
• Probation and parole and/or court documents (if applicable)
• We cannot complete your application without this information. Without the required information, your appointment may have to be rescheduled, or your fee may be set at the standard rate $90 fee.

Call us to schedule your intake appointment. Walk- in appointments are also welcome.

Click here to view the Peak Wellness Center Client Handbook

Click here to view the Peak Wellness Center Non-Discrimination Notice

Since Peak Wellness Center charges on a sliding fee scale, your fee is based on income and your ability to pay. Please report any changes in your income or financial status, including the number of people dependent on your household income, as soon as possible.

Tri-Care Insurance Holders: You are responsible for obtaining a referral to Peak Wellness Center prior to your intake appointment.

Release of Information: In the event that you would like Peak Wellness Center to release your information or receive information from outside sources, such as attorneys, family members, etc., please bring the exact name of the person or agency, current address, phone and fax numbers to your appointment.