Forms
Please print and fill out the forms listed below and bring with you to your first appointment. The Insurance Questions form gives you all the questions to ask your insurance company to find out your benefits, including whether you need to pre-certify the sessions prior to your first appointment. If you have any questions regarding these forms, feel free to email/call me.
- Disclosure form (PDF) This is a HIPPA mandated form disclosing my qualifications and allows me to bill your insurance company.
- Client Information Sheet (PDF) This form gives me all the necessary information to open a client file.
- Insurance Questions (PDF) Use these questions to call your insurance company to find out your mental health benefits including copay, coinsurance and whether you need to pre-certify sessions.
PAYMENT FOR SESSIONS BY CREDIT CARD
If you wish to pay your copay or session fee by credit card, please use the drop down box below to select the payment amount and click on the "Pay Now" button which will take you to a Paypal screen to put in your credit card information.
