If you have an upcoming appointment scheduled at WCMHC, please complete the appropriate paperwork below prior to your appointment and bring it with you to the office so it can be reviewed by the clinician you will be seeing. This will allow that more time during the initial appointment can be spend on discussing the current problem areas and/or treatment options rather that obtaining the information in this packet.
If you do not yet have an appointment scheduled with us at WCMHC, please contact the office for more information regarding our current openings.
Please note that at this time, New Client forms can now be completed using Adobe Acrobat Reader and submitted via email. Please download the applicable forms below and click here for instructions on how to sign electronically. Once finished, please email the completed documents to firstname.lastname@example.org.
If you cannot submit electronically, please print off the applicable forms below and bring to the Winchester CMHC Office located at 36 Ricketts Drive, Winchester, VA 22601
You can also speak to your WCMHC healthcare provider about other options for turning in your signed forms.
All Clients need to read the WCMHC Notice of HIPAA Privacy Practices
Tele-Therapy Clients will need to fill out the Tele-Therapy New Client Packet and either the Medicaid Packet or the Private Insurance/Medicare Packet depending on which insurance the client has
Medicaid Insurance Packet New Client Packet
Private Insurance / Medicare Insurance New Client Packet
Tele-Medication Management Clients will need to fill out the Tele-Medication New Client Packet and the appropriate New Client Insurance Packet below.* Please note that a Child/Adolescent Packets apply to clients under the age of 18.
Adult Medicaid Insurance Packet
Adult Private Insurance / Medicare Insurance Packet
Child / Adolescent Medicaid Insurance Packet
Child / Adolescent Private Insurance / Medicare Insurance Packet
*If you have appointments scheduled for both Therapy & Medication Management services, please fill out both the Tele-Therapy New Client Packet and the Tele-Medication New Client Packet. However, please only fill out the appropriate New Client Medication Management Insurance Packet paperwork (as the New Client Therapy Insurance Packet paperwork is already included in the packet).