New Patient Forms to Complete

All new patients are asked to provide us with the requested information on order to begin counseling.
Please complete the following forms and return to Diedrich's Counseling via one of our secured options:
Dropbox (we will send a direct link to you)
Fax (414-585-9867)
Mail (4402 S 68th St Suite 102, Greenfield, WI  53220)
The forms can be printed off and filled out by hand, or you can type out your information before printing and signing.  Please let us know if you have any questions or technical difficulties while completing the forms and we would be more than happy to assist you.
We will also need a copy of both sides of your insurance card.  That can be done by copy machine, scanner or by taking a picture and including it with your completed forms.
During your first appointment, Ellen will go over the forms and address any questions or concerns you have.