New client forms are located below as Adobe PDF documents for the ease of downloading and printing at home or work.
Please print these forms, fill them out and bring them with you to your first appointment. HIPPA Disclosure is listed as a separate document for your information.
Insurance Billing
We are pleased to bill your insurance for you. Please contact your insurance company before your first appointment so that you know the extent of your coverage, deductible, co-insurance or co-payment to bring with you to your session.
You will also need to secure any necessary authorization from your insurance carrier if that is necessary or a referral from your doctor if that is required by your insurance provider.
Please bring your insurance card with you to your first appointment so that the front and back sides may be copied to bill your insurance directly. Your insurance will be billed for you, however, should your insurance choose not to pay the full fees, you will need to pay the remaining balance, please be prepared to pay your co-pay at the time of your appointment.
We like to take care of the "business" part of the appointment at the beginning of the session so please have your co-pay ready and we will also schedule your next appointment at the beginning of the session so we may completely focus on you.
Forms and Paper Work
Below are forms and paperwork in Adobe for you to download, print and fill-out to bring with you to your first appointment.
Please download the forms and if you have questions about any portion of it, please call me prior to your appointment.
INSURANCE
If you are utilizing insurance to pay for your session, please also download the Insurance form and simply sign and date on the signature lines, there is no need to fill out any of the rest of the form, and bring your insurance card with you to your first appointment to copy and keep on file.
You might want to call your insurance company to verify Mental Health benefits and ascertain your deductible amount, sometimes there are Pre-Authorizations Required by insurance companies and they can assist you with starting that process.
Forms
Please print out the forms on the right, complete them and bring them with you to your first appointment. If you have questions regarding the forms we will review the forms at the beginning of our first session. It saves time if you have the forms completed and we can focus all of our attention on you. If we are billing your insurance for you please print out the HCFA/Insurance paper and sign it, you do not need to fill in all the details as long as you bring your insurance card so we may copy the front and back of the card.
There are two more forms, one for children with a detailed history and for couples that you may complete and bring with you to the first or second appointment.
Please fill out the adult or child Intake Packet as this is the primary form to fill out for the first appointment which is necessary to have completed before we can meet and talk.
By law I am required to provide you with the therapist professional disclosure form and the HIPPA forms, you are welcome to print these and keep these for your records or not. They are separate documents.
