Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Welcome to the Wellness Workx Client Portal registration. Prior to our work together the following paperwork is required.
Under the Treatment label complete the Psychosocial History.
Under the Forms label complete the Hippa and Privacy Practices
forms.
Thank you in advance for your time on this!

Client Type

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )






( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Cancellation Fee: $25.00
An appointment maybe cancelled by the client up to 24 hours before the scheduled appointment. If the 24 hour window has passed please call me to discuss the circumstances.
( Type Full Name )
Appointment Scheduling
I schedule the appointments directly with you. Please call, email or text me to schedule or cancel an appointment.
( Type Full Name )