Patient Packets and Consent Forms

Primary Applications and Forms

Application For Services

Apply For Services

Sliding Scale Application

Financial Assistance Form

Records Request Form

Release of Information

Release of Information Form

Consent Forms

Program Forms

New Patient/Consent to Treatment Service Forms

Consent To Treatment Form

BRS Service Forms

BRS Form

EFM-W Service Forms

EFM-W Form

IIP Service Forms

IIP Form

MOVE Well Service Forms

MOVE Well Form

New Developed Nations Forms

Go To Form

OP-SUD Adult Forms

Go To Form

OP-SUD Youth OP/CoIOP Forms

Go To Form

OP-WISE Service Forms

Go To Form

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.