If you're a new client, please complete the following forms and bring them to your first therapy session.
* Intake Form * Consent for Services Form * Insurance Form * Financial Responsibility Policy
* Notice of Privacy * Credit Card Authorization Form * Good Faith Estimate Form (Self Pay/Out of Network)
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions, as this is YOUR RESPONSIBILITY:
- Do I have mental health insurance benefits?
- What is my deductible and has it been met?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
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