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Patient Forms
Below you will find a variety of forms for new patients or individuals considering our services. These forms are subject to revision without advanced notice.
Notice of Privacy Practices
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This document describes how we handle your private information.
Patient Services Agreement
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This document outlines our policies for providing services and a general description of our approach to therapy.
RWPS Charitable Grant System
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This form describes our Charitable Grant System for individuals who need our services but otherwise cannot afford to pay for them.
RWPS Charitable Grant Application
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This form is to be completed by patients who wish to receive a Charitable Grant. It contains guidelines for grant amounts. Please note that the dollar amounts included are guidelines only and are subject to change. When applying for a grant, we ask that you prayerfully consider what you could afford to pay per session, keeping in mind the need for a just distribution of our resources.
Adult New Patient Information Form
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This form helps us get to know you and provides us with important background information to help plan your care. Please bring the completed form to your first appointment. There are two versions:
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To type in your answers on the computer and then print use this version: Adult New Patient Information Form—Type
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To print the form and hand write your information use this version: Adult New Patient Information Form—Hand Write
Child New Patient Information Form
**Please note, we prefer you bring a hardcopy of these forms to your first appointment. For your privacy, please do not try to submit them electronically or via e-mail.
Thank you!**
For more info or to make an appointment, call 513-407-8878.
Ruah Woods Psychological Services 6675 Wesselman Rd. Cincinnati, OH 45248
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