Intake form

WellHouse Intake Information

Thank you for considering The WellHouse as your place of faith-based restoration and healing.

• Below is an intake form to provide The WellHouse with some basic information. Please complete the entire form and include a phone number or email that can be reached after 5 PM (CST). Feel free to ask any questions you may have during your intake call.

• Once submitted, please allow 24 hours for contact to be made in order to complete the verbal portion.

• If Saturday or Sunday (any time) is better for you, please specify. This call typically takes 15-30 minutes.