Everything you need, In one place.
All Mind Speak intake forms, consents, and payment portals — organized so you can find exactly what you need and get started without the runaround.
All forms are securely processed through DocStar. Your information is protected and HIPAA-compliant
Starting Your Journey
Patient Intake Form
Your first step with Mind Speak. This form collects your contact information, insurance details, diagnosis background, and service preferences. A Mind Speak coordinator will follow up within 1–2 business days to schedule your first session.
What to have ready: Insurance card, primary physician name, emergency contact info, and any current diagnoses or medications.
~15 Mins
HIPAA Secure
Notice of Privacy Practices
This document explains your rights as a patient and how Mind Speak uses and protects your health information. Reading and signing this form is required before beginning therapy services — it's your guarantee that we handle your information with care.
Key rights covered: Access to your records, limits on information sharing, and how to file a complaint if needed.
~5 Mins
HIPAA Secure
Payments & Authorization
Health Insurance Copayment Portal
Securely pay your copayment, deductible, or outstanding balance online at any time. Mind Speak accepts Medicaid, Medicare, and all major managed care plans.
Payment Authorization Form
Authorize Mind Speak to process payments via your insurance, Medicaid, or Medicare on your behalf. This form is typically completed once and remains on file. You may need to update it if your insurance plan changes.
When you'll need this: At intake, when changing insurance plans, or when adding an authorized representative such as a caregiver or legal guardian.
~9 Mins
HIPAA Secure
For Mental Health Professionals
Independent Contractor Application
Interested in joining the Mind Speak team as an independent contractor therapist? This application is for licensed clinicians who share our community-first approach. Mind Speak therapists have no offices — you'll meet clients where they are across NYC and Westchester.
We're looking for: Licensed clinicians with experience in developmental disabilities, dual diagnosis, or community mental health.
~20 Mins
HIPAA Secure
Not sure which form you need?
Our team is happy to walk you through the process — in English or Spanish.
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