Forms

 

Before your first visit, you’ll need:

  • To call your insurance company to determine your specific mental health care benefits.  This includes securing authorization for all services prior to your first appointment.
  • Your insurance card.
  • The fully-completed forms below.

 

Payment Arrangements:

Please be aware charges will apply for requests that go beyond the scheduled session time. Telephone calls and written communications will be charged on a prorated basis.

PLEASE CALL MY BILLING SERVICE AT 1-800-789-5761 x0 and ask for someone to verify your benefits.  This call is REQUIRED BEFORE our first appointment if you are using insurance for your visit.

Forms for your first appointment:

Please download, print, complete and sign the appropriate set of the forms from your choices below before your first appointment.  Forms should not be printed two-sided.  We will review the new patient forms together during your first visit.


PLEASE DO NOT BRING COMPLETED FORMS ON DOUBLE-SIDED PAGES as they will be scanned into an electronic medical record, which requires SINGLE-SIDED PAGES ONLY.