New Client Forms and Referral Documents

Please find a copy of our referral form below. This form is to be used by other agencies or providers wishing to refer a client to our facility. You may either fax this completed form to 910-833-5905 or email it to [email protected].  SDWC Referral Form

Below is a blank copy of our consent form for release of interagency communication Blank consent

Below are the forms that are required for new clients to complete prior to the first appointment.

*Medicaid requires a lengthier intake packet than private insurance does so please be sure to fill out the correct packet.

Medicaid Intake Packet

Final SDWC Private Intake

If you have any questions while completing these forms, please feel free to leave the areas you have questions about blank and ask our admin staff about them prior to signing.

Thank you for choosing Sand Dollar. We look forward to meeting you!

If you have not set up your first appointment feel free to call our office at 910-833-5902 OR fill out the form below.