Forms

New Client Forms

Below are PDF copies of new client forms for your reference.

New clients will complete consent forms through the secure Jane App client portal, however, sometimes it is easier to read them in the PDF format before completing them in the portal.

These are for reference only and completion of the PDF forms does not make you a client of OtterWell Mental Health.

11.28.2025 OtterWell MH Notice of HIPAA Privacy PracticesDownload
11.28.2025 OtterWell MH No Surprise Billing NoticeDownload
5.21.2026 OtterWell MH Informed ConsentDownload
5.21.2026 OtterWell MH Telepsychology Informed ConsentDownload
11.28.2025 OtterWell MH Good Faith Estimate TemplateDownload
5.21.2026 OtterWell MH Fee For Service & Credit Card AuthorizationDownload
11.28.2025 OtterWell MH Emergency ContactDownload
11.28.2025 OtterWell Mental Health ROIDownload