Patient Forms

Below you will find a variety of forms for new patients or individuals considering our services.

Notice of Privacy Practices
This document describes how we handle your private information.

Patient Services Agreement
This document outlines our policies for providing services and a general description of our approach to therapy.

RWPS Charitable Grant Program
This form describes our Charitable Grant Program for individuals who need our services but otherwise cannot afford to pay for them.

RWPS Charitable Grant Application
This form is to be completed by patients who wish to receive a Charitable Grant. It contains guidelines for grant amounts. Please note that the dollar amounts included are guidelines only and are subject to change. When applying for a grant, we ask that you prayerfully consider what you could afford to pay per session, keeping in mind the need for a just distribution of our resources.

“Give thanks to the LORD, for he is good; his steadfast love endures forever!”
– Psalms 118:1