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📝 LifeWay Consent Form Gateway

Welcome to LifeWay Center—where healing meets hope. As a faith-driven organization offering Christ-centered medical and mental health care, we're honored to walk with you or your loved one toward healing and restoration.

"They will soar on wings like eagles..." – Isaiah 40:31

Before beginning services, please review and complete all required digital consent forms based on the individuals you are registering.

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Birth Date(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Status(Required)

Issue(Required)

Therapy

Medical

Wellness

Type of Insurance(Required)

Insurance Number(Required)

Emergency Contact Full Name(Required)

Emergency Contact Phone(Required)

How did you learn about us?(Required)

Name of Person Referred By(Required)

Please indicate how many people you’re enrolling in each service category. The form will dynamically display the appropriate consent packets.

Adults for Mental Health Therapy [0-10]

Consent for Treatment
HIPAA Acknowledgment
Telemental Health Consent
Consumer Rights
No-Harm Contract (if applicable)
Advance Directive Acknowledgment

Client Name	Actions

There are no Adults.

Minors for Mental Health Therapy [0-10]

Consent by Parent/Guardian
HIPAA Acknowledgment
Emergency Services Agreement
No-Duplication of Services Attestation
Consumer Rights
Food Safety Agreement
School/IEP Records Release (optional)

Minor Client Name	Actions

There are no Minors.

Females for Medical Services [0-10]

Full Name	Actions

There are no Females.

General Medical Consent
HIPAA Policy
Pelvic Exam Consent (if applicable)
Medicare/Medicaid Release
Telehealth Consent

Males for Medical Services [0-10]

Client Full Name	Actions

There are no Males.

General Medical Consent
HIPAA Policy
Medicare/Medicaid Release
Telehealth Consent

Confirm You’ve Read the LifeWay Handbook

Please take a few minutes to read the official LifeWay Client Handbook (PDF), which outlines your rights, responsibilities, and our care model.

Sign Each Form Digitally

All forms must be signed by the client or a legal guardian (for minors). Be sure to complete all sections accurately to ensure smooth onboarding.

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📝 LifeWay Consent Form Gateway

Please indicate how many people you’re enrolling in each service category. The form will dynamically display the appropriate consent packets.

Confirm You’ve Read the LifeWay Handbook

Sign Each Form Digitally

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