Before Your Appointment

Thank  you for choosing WellSpring!

The first appointment is considered an assessment.  This appointment lasts approximately one hour and 15 minutes.  The first 15 minutes is spent processing and completing paperwork.  After the paperwork is complete, the client will then meet with the therapist for approximately 1 hour.

What to bring to your first appointment:

  • Your insurance card (Molina, CareSource, Amerigroup, Medicaid, Medicare, or Private Insurance)
  • If you are a Sliding Fee Client – a copy of 1 month’s worth of paystubs OR a copy of last year’s taxes.
  • Payment in full
  • A valid photo ID
Please note:  Children 14 and under cannot be left in the waiting room by themselves.  If the client is a child, then a parent or guardian must be in the waiting room at all times during the client’s appointment with the therapist.  No child under the age of 14 may be “dropped off” for their appointment.

Privacy & Client Rights

Client Rights and Grievance Procedure

This client rights and grievance policy will be given to each client at admission, with documentation kept in the client’s record, and the policy will be posted at each program site in a place accessible to clients.  All staff will receive and review a copy of the client rights and grievance policy and documentation of staff’s agreement to abide by the policy and procedure will be kept in their personnel files.
All grievances must be written, dated and signed by the client or the person filing the grievance on behalf of the client and should include the date, approximate time, description of the incident and names of the individuals involved in the incident/situation being grieved.  Grievances should be given to the Clients Rights Officer, or in the event the client rights officer is not on the premises, the grievance can be given to the Office Manager.  Any program supervisor will assist you in filing a grievance upon your request.  All grievances, including a copy of the grievance, documentation reflecting the process used and resolution/remedy of the grievance and documentation, if applicable, of extending the time period for resolving the grievance beyond twenty-one (21) calendar days will be kept on file for two years from resolution and will include a copy of the grievance, documentation reflecting the process used and resolution/remedy of the grievance, and, documentation if applicable, of extenuating circumstances for the extending the time period for resolving the grievance beyond twenty-one calendar days.
Within three (3) working days of receiving the grievance program, staff will provide client with written knowledge that includes: a) date the grievance was received, b) summary of the grievance, c) overview of the grievance investigation process, d) timetable for completing the investigation and notification of the resolution, and e) treatment provider contact person’s name, address and telephone number. With twenty-one (21) calendar days of receiving the grievance, the program will make a resolution decision on the grievance.  Any exceptions that cause this time period to be extended will be documented in the grievance file and written notification will be given to the client or persons filling grievances on the client’s behalf.
At any time clients or persons filing grievances on the client’s behalf have a right to file a grievance with any of the organizations listed below:

Ohio Department of Mental Health and Addiction Services (OMHAS)

30 East Broad Street, 36th Floor
Columbus, OH 43215
PH: 614-466-2596

Mental Health and Recovery Board

Of Clark, Greene & Madison Counties

1055 East High Street
Springfield, OH 45505

Ohio Legal Rights Services

50 West Broad Street, Suite 1400
Columbus, OH 43215-5923

Client Rights

Persons who receive mental health treatment services and alcohol and drug addiction treatment services at WellSpring have the following rights:
  1. The right to be treated with consideration and respect for personal dignity, autonomy and privacy.
  2. The right to reasonable protection from physical, sexual or emotional abuse, neglect, and inhumane treatment.

  3. The right to receive services in the least restrictive, feasible environment.

  4. The right to participate in any appropriate and available service that is consistent with an individual service plan (ISP), regardless of the refusal of any other service, unless that service is a necessity for clear treatment reasons and requires the person\'s participation.

  5. The right to give informed consent to or to refuse any service, treatment or therapy, including medication absent an emergency.

  6. The right to participate in the development, review and revision of one\'s own individualized treatment plan and receive a copy of it.

  7. The right to freedom from unnecessary or excessive medication, and to be free from restraint or seclusion unless there is immediate risk of physical harm to self or others.

  8. The right to be informed and the right to refuse any unusual or hazardous treatment procedures.

  9. The right to be advised and the right to refuse observation by others and by techniques such as one-way vision mirrors, tape recorders, video recorders, television, movies, photographs or other audio and visual technology. This right does not prohibit an agency from using closed-circuit monitoring to observe seclusion rooms or common areas, which does not include bathrooms or sleeping areas.

  10. The right to confidentiality of communications and personal identifying information within the limitations and requirements for disclosure of client information under state and federal laws and regulations.

  11. The right to have access to one\'s own client record unless access to certain information is restricted for clear treatment reasons. If access is restricted, the treatment plan shall include the reason for the restriction, a goal to remove the restriction, and the treatment being offered to remove the restriction.

  12. The right to be informed a reasonable amount of time in advance of the reason for terminating participation in a service, and to be provided a referral, unless the service is unavailable or not necessary.

  13. The right to be informed of the reason for denial of a service.

  14. The right not to be discriminated against for receiving services on the basis of race, ethnicity, age, color, religion, gender, national origin, sexual orientation, physical or mental handicap, developmental disability, genetic information, human immunodeficiency virus status, or in any manner prohibited by local, state or federal laws.

  15. The right to know the cost of services.

  16. The right to be verbally informed of all client rights, and to receive a written copy upon request.

  17. The right to exercise one\'s own rights without reprisal, except that no right extends so far as to supersede health and safety considerations.

  18. The right to file a grievance.

  19. The right to have oral and written instructions concerning the procedure for filing a grievance, and to assistance in filing a grievance if requested.

  20. The right to be informed of one\'s own condition.

  21. The right to consult with an independent treatment specialist or legal counsel at one\'s own expense.