Patient Packets and Consent Forms

Primary Applications and Forms

Application For Services

Sliding Scale Application

Records Request Form

Release of Information

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-SUD Adult Forms

OP-SUD Youth OP/CoIOP Forms

OP-WISE Service Forms

How can we Help?

Excelsior Wellness has multiple organizations, but one common purpose. Find out which of our programs is right for your family. Excelsior accepts most health care plans.

Welcome to Excelsior Wellness

Discover the heart of Excelsior Wellness: learn about our passionate mission to empower healthcare and create a more resilient, connected, and thriving community through comprehensive care and innovative services.