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Forms PDF Print E-mail

IMPORTANT FORMS FOR CLIENTS

Below are the forms that need to be filled out by all new clients of Wellspring Counseling. All the forms below with an asterisk (*) must be completely filled out prior to your first session.

The forms are all in PDF format so you will need to have Adobe Reader, which you can obtain for free.

 

* Agreement, New Clients

* Credit Card Payment Consent Form

* Client Information and Questionnaire

* Confidentiality Form

* HIPPA Consent Form

Client Satisfaction Survey

Consent for Counseling Services to Children

Authorization for Release of Information

Using Insurance for Mental Health Services

Application for Reduced Fee

* Necessary forms for all new clients


 

 
HOW TO HELP PDF Print E-mail

 

Any successful organization has people standing behind it, believing in the mission and vision. If you would like to volunteer or become a donor to Wellspring Counseling any contribution you can make would be greatly appreciated.

We have many ways in which you can make a donation to Wellspring Counseling. It costs us approximately $95 to counsel an individual, family or marriage. The actual amount of money we take in per session is in the $40 range. Donors in their generosity make up this difference. We have many different ways in which you can make a contribution to our ministry. As a nonprofit 501(c)3 organization, your contribution may be tax deductible.

1. By credit card. Send your donation via secure payment online.

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2. By mail. You can send your donation to this address:

Wellspring Counseling
Attention: Donations
1345 Monroe Avenue NW
Suite 254
Grand Rapids, MI 49505


3. By phone. Call our offices (616) 460-3341 and talk to us personally to make your donation.


OTHER WAYS TO DONATE

Whether supported through an outright gift or planned gift, all Wellspring programs are made possible through the generosity and commitment of people like you. Stock certificates or a planned gift to Wellspring helps to ensure the future of the services and programs we provide and may further your financial goals.

Donating stock certificates
Electronic delivery of stock shares is the most secure and expedient delivery process available and provides efficient internal control as well as cost savings. However, you may also transfer certificates directly. To help you facilitate a gift of stock, please call our executive director at our offices at (616) 308-1503.


What are planned gifts… Planned gifts include gifts through your will, charitable gift annuities, gifts of life insurance, pooled income funds, and charitable trusts.

Bequest
Some of our supporters make charitable gifts by naming the Wellspring Counseling as a beneficiary in their wills.

Gift of Life Insurance
Some of our supporters no longer need their life insurance, that was purchased years ago to provide for children or other family members, and donate the policy to the Wellspring Counseling.

Pooled Income Fund
Your gift of money, marketable securities, or both is invested together with similar gifts from other supporters.

Charitable Lead Trust
Individuals with very large estates can use a charitable lead trust to benefit Wellspring Counseling and pass principal to family members with little or no tax penalty.

Gifts of Retirement Plans
Your IRA assets will be transferred to a charitable remainder trust, the trust will provide life income to the beneficiary, and then an eventual gift to Wellspring.

 

 
CLIENT SATISFACTION SURVEY PDF Print E-mail

If you are a current or past client and have recieved services from Wellspring, please take a couple of minutes and fill out the survey at the link below. Your comments and opinions are very important as they allow us to evaluate and improve our service to you. The survey is anonymous.