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Forms

Consent To Begin Services 

Adult Consent For Services

Welcome to Garcia’s Family Wellness Clinic, LLC (GFWC) where our vision is to provide better quality of life through mental health education and exceptional care. If you are ready to begin services for yourself, child, or family please continue to review and consent to our clinic's rules and policies.

This is the first step in beginning services at our clinic and completing the below form is required. The information you provide us will be kept private and confidential and will help your provider learn how to care for you or your family in the best of ways. 


*This form may be completed on paper in-person at our clinic*

 
Welcome to Garcia’s Family Wellness Clinic, LLC (GFWC) where our vision is to provide better quality of life through mental health education and exceptional care.


 
Since this is your first visit, we hope what is written here can answer some of your questions as you seek care with us. When you provide information through this electronic form, be assured that your information will remain private and will help your provider best help you. In addition, as you consent for care in the following forms you are stating that you understand and will follow the outlined information for any and all services at Garcia's Family Wellness Clinic, LLC (GFWC)  and related companies. 


 

Adults Patients Start Here

*Parents looking for your kid's section to begin services, please scroll down to the Pediatric & Children Section ↓ *

Please complete the following fields for Adults seeking services. Fill in every blank and click submit at the end of the form.

 

All demographic information must be filled as shown in your legal documents or Driver's License. 

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

Click here to download form

information about our informed consent and primary take aways. 

End of Adult Consent Form

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