Multiple Service Client Screening

Please review and complete the client screening form to request an appointment.

Thank you for your interest in Intuition Wellness Center. Here is some information that may be helpful:

  • Intuition Wellness Center serves individuals ages birth to 25 and caregivers.
  • Some services are billable to Blue Cross Blue Shield and Aetna insurances.
  • Self pay fees for services are available to view on our Fee Schedule.
  • Naturopathic medical services are not billed directly to insurance. You may request a superbill.
  • Intuition Wellness Center’s training department provides counseling, school consultation and psychological testing with doctoral students at a reduced fee. Typically, these services are not billable to insurance.
  • Team members at Intuition Wellness Center have limited availability. Prospective clients with flexibility of scheduling and team member preference are the most successful in matching to services.
  • The Intuition Wellness Team values a thoughtful process when it comes to matching potential clients with a provider. It typically takes 3-7 days for the team to formulate a response to requests for an appointment. Occasionally the wait may be a bit longer, such as during holidays or times when the volume of requests is particularly high. Thank you for your patience.
  • If you are seeking information on our Wellness Programs, you are not required to complete the following questionnaire.
  • The questionnaire below is required in order to determine Intuition Wellness Center’s ability to meet your needs for clinical services. To request services, please call 520-333-3320 or complete the following prospective client questionnaire:









    Self (adult)ChildFamily





    MaleFemaleOther










    BCBSAetnaPsychology TodayInternet (eg., Google)PCPOther ProfessionalOther



    Any Licensed Team MemberDoctoral Student (for counseling, school consultation and psychological testing only)Specific Team Member



    Naturopathic MedicineCounselingPlay TherapyParent GuidancePsychological TestingPediatric Occupational TherapyParent-Child Relationship AssessmentSchool Success ConsultationPhysical ExamSports PhysicalSick VisitFood Allergies and IntolerancesNutrition AdviceVaccination CounselingMood and Behavior IssuesInfant and Child Sleep SupportDigestive ConcernsRecurrent InfectionsDermatological ConditionsHandling Puberty Gracefully and OptimallyYogaParent Education


    If you are interested in enrolling in Taekwondo classes, please visit the TKD Wellness website.





    Eating DisorderAddictionNone of These



    YesNo



    YesNo



    YesNo



    YesNo
    (If so, please call 911 or the crisis line at 1-866-495-6735 to speak to a crisis counselor.)



    YesNo



    YesNo



    YesNo
    (If so, please call the crisis line at 1-866-495-6735 to speak to a crisis counselor or call 911.)



    YesNo



    YesNoNA, prospective client is an adult



    YesNoNA, prospective client is an adult



    Please supply supporting court documents at intake or scan and email them to contact@intuitionwellness.com prior to your intake appointment.



    MedicalBehavioral HealthOtherNone


    If you have previous behavioral health or medical treatment history, please bring a copy of records (e.g., treatment summary, treatment plan, testing reports, etc) at the initial intake appointment. You can also email PDF documents to contact@intuitionwellness.com.



    Licensed Team Member - See Fee ScheduleDoctoral Student - See Fee ScheduleBCBSAetna


    If you choose Insurance payment, please provide the following information for insurance verification (Please note that doctoral students counseling services are not billable to insurance):





    Prospective testing clients only:


    NoYes



    NoYes


    Thank you for taking the time to complete the questionnaire. Please click “Request an Appointment” to submit to the Intuition Wellness Center team for review and processing. It typically takes 3-7 days for the team to review requests and formulate a response. Intuition Wellness Center receives many requests each week. If caseloads are full, you will be given other referrals.


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