New Patient Intake Form | Healing Arts & Wellness West Palm Beach

Step 1 of 6

Who needs support?

This helps us match you with a therapist who specializes in working with your specific age group and situation.

Step 2 of 6

What would you like to work on?

Select all that apply. Your clinician will review these before your first session.

Step 3 of 6

How would you like to meet?

We offer in-person sessions at our West Palm Beach office and telehealth sessions anywhere in Florida.

🏢 In-Person WPB Office

💻 Virtual Telehealth FL

🔀 No Preference Either works

Step 4 of 6

What is your insurance?

We are in-network with major carriers. We'll verify your benefits for free before your first session.

Select Your Insurance Plan

Member ID (Optional — We can look it up)

💡 We verify for free. Once you submit this form, our billing team will call your insurer directly and confirm your exact copay and coverage before your first appointment. No surprises.

Step 5 of 6

When works best for you?

Select your preferred days and times. We'll do our best to match your schedule.

Preferred Time of Day

🌅 Morning8 AM – 12 PM

☀️ Afternoon12 – 5 PM

🌙 Evening5 – 8 PM

How soon do you need to be seen?

Step 6 of 6

Almost done — your contact information

We use this to confirm your appointment and verify your insurance. All information is encrypted and HIPAA-secure.

First Name *

Last Name *

Phone Number *

Email Address *

Date of Birth

Preferred Language

Anything else you'd like us to know? (Optional)

🔒 Your privacy is protected. This form is transmitted using encryption. Your information will only be used to match you with a therapist and verify your insurance. We never sell or share your data. By submitting, you agree to our Privacy Policy & HIPAA Notice.

✅

Thank You! We'll Be in Touch Soon

Your intake form has been received. A member of our team will call you within 1 business day to confirm your appointment and review your insurance coverage.

📞

Need to reach us sooner?

(561) 787-9494

📍

Our Office

4300 Miller Ave, West Palm Beach, FL 33405

← Return to Homepage