Patient Info - Embracing Life Wellness Center

We are pleased to welcome you to our office.

WE ASK THAT PATIENTS HAVE ALL VALANT CLIENT PORTAL INFORMATION COMPLETED PRIOR TO THEIR SCHEDULED APPOINTMENT.

Due to our schedule constraints, if you do not arrive at our office by the time indicated, there is a possibility we will have to reschedule the appointment to another date. Our office will contact you 1-4 days prior to the date of your appointment to confirm that you intend to keep this appointment.

*We must have verbal confirmation of your intention to attend your appointment at least 24 hours in advance! Failure to confirm with our office will result in a cancellation of your appointment*.

Please be sure to bring with you a photo ID, your insurance card and any applicable co-pay or deductible that you will be responsible for. Also, it is advised that you contact your insurance carrier prior to the appointment date to inquire as to what outpatient mental health benefits are available with your particular policy. If any pre-authorization is required, you will need to secure authorization prior to your appointment.

Please note, if you have reports you wish to give to the doctor it is your responsibility to make copies of those reports prior to your appointment. We are unable to make copies for you. If the patient is under the age of 18, we require that at least one parent or legal guardian accompany them to the appointment. If you are not a biological parent we will need a court ordered document signed by a judge or birth certificate listed you as the legal guardian. We also ask that you only bring the child for whom the appointment is scheduled to our office. Please make arrangements for other minor children to be cared for while you attend this appointment.

Mental Health

Our office has an extensive waiting list of new patient’s wishing to move their appointment to an earlier date. If for any reason you need to cancel or re-schedule your appointment, please contact. Your courtesy in canceling an appointment that you may not be able to keep may allow us to move a new patient to an earlier date. We will not schedule a future new patient appointment for you if you “no-show” or fail to show up at the time indicated above or fail to contact our office to cancel you appointment 24 hours in advance.

Our office policy for missed appointments:

A 24-hour notice is required for canceling all appointments, without notice a fee will be applied to your account.
For a new patient, the appointment will not be rescheduled without approval from management. If rescheduling is approved, a $100 fee must be paid prior to making a new appointment.
For an established patient, a $50 fee will be applied to your account and must be paid prior to or at the time of your next appointment.

VALANT CLIENT PORTAL

NEW PATIENT FORMS

IF YOU ARE A NEW PATIENT PLEASE DOWNLOAD AND FILL OUT THE

DOWNLOAD PATIENT FORMS

AUTHORIZATION OF RELEASE FORM

IF YOU ARE AN EXISTING PATIENT IN NEED OF AN AUTHORIZATION OF RELEASE FORM, PLEASE CLICK BELOW.

AUTHORIZATION OF RELEASE FORM

CREDIT CARD ON FILE AUTHORIZATION

CREDIT CARD AGREEMENT

Accepted insurances:

Aetna
Blue Cross/Blue Shield (BCBS) Selected Plans
Cigna Behavioral Health
Humana
Meritain
Seminole Tribe of Florida
Tricare
United Behavioral Health
United Medical Resources (UMR)

Not a provider for:

Psychcare
Unipsych
Medicare/Medicaid
MHnet

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