Advanced Counseling and Testing Solutions, LLC

Lancaster: 717-208-6599 Wyomissing: 484-987-7116

Treatment Consent

Forms

HIPPA Consent Form

Financial Policy

Adult Intake Form

Patient Privacy Act (no need to print
for your reference only)

Counseling Services Wyomissing PA

Release of Health Care Information
(please include referring physician, spouse, etc.)

Please print and complete the above 5 forms (excluding the Patient Privacy Act, this is for informative purposes only) prior to your appointment at ACTS. This will help to eliminate unnecessary wait time in the reception area.

Thank you!