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  • Excelsior Wellness

Contact Us Today
509-559-3100

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    • About Excelsior Wellness
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    • Commitment
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Patient Packets and Consent Forms

RELEASE FORMS

  • Release of Information
  • Records Request Form

CONSENT FORMS

  • Group Telehealth Consent Form
  • General Release of Liability Form
  • Telehealth Consent Form


PROGRAM FORMS

  • New Patient/Consent to Treatment Service Forms
  • BRS Service Forms
  • EFM-W Service Forms
  • IIP Service Forms
  • MOVE Well Service Forms
  • New Developed Nations Forms
  • OP-MH Service Forms
  • OP-SUD Adult Forms
  • OP-SUD Youth OP/CoIOP Forms
  • OP-WISE Service Forms

 

  • Notice of Privacy Practices

Excelsior Wellness
Main: 509-559-3100 ~ Fax: 509-588-7437
3754 W Indian Trail Rd. Spokane, WA 99208
Email: info@excelsiorwellness.org


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