ONLINE, IN-HOME, OR IN OFFICE SERVICES AVAILABLE DURING COVID!
**LINK to email us any time and send back your forms.**
Please make sure to return these papers already filled out at your first appointment so that you will not use your appointment time to fill out paperwork. Thank you!
If you are coming in for COUPLE or FAMILY therapy, please also fill out this form:
3. Español- papeles para su primera cita
Por favor, asegúrese de llevar estos documentos ya llenado a su primera cita para que usted no tenga que utilizar su tiempo de la cita para llenar papeles. Gracias!
If you would like ONLINE or PHONE counseling, please add this form:
You may need the form below if you want to authorize me to speak to your doctor, previous therapist, a school, or somebody else.
5. Authorization To Exchange and Release Information
And…..For Your Info (no need to print this out):
Notice of Privacy Practices(FYI)
PLEASE NOTE: if we have set a home visit, please wear a mask for the duration of our stay and social distance. We will do the same. Please let us know ahead of time if you are unable to keep your home visit.
If you’re coming to the office, you will be seen exactly at your appointment time, so if you come earlier you will likely have to wait until your appointment time.
If we have a phone session, we will call you at the exact time. If we have a video session, you may login at any time but we will become available at exactly the appointment time.
CANCELLATION POLICY: If your appointment is on a Monday, please call by the previous Friday at 5:00PM if you need to make changes. If you need to cancel an appointment on a different day, a minimum of 24 hours advance notice is required. If you do not cancel your appointment as above you will be personally billed $ 150.00 for the missed appointment.
PAYMENTS: Payment is expected at the time of service. If using insurance, it is your responsibility to obtain a pre-authorization if you need one, and know your exact co-payment or deductible. Please bring your insurance card, co-payment in cash or check, and authorization code or letter with you if you need an authorization. If you do not have the above at the first visit, please be prepared to pay my full fee in cash or check at your first visit.
If you have an emergency before our meeting, please call the Crisis Line at 1-888-724-7240.
I am looking forward to meeting you!
Are you extra green and environmentally friendly? Consider filling out the paperwork online through a free application like Adobe Reader (please use your real signature), and sending back the paperwork electronically, so that you will not waste paper or ink. Please note that sending a regular e-mail equals to sending a postcard, and it is not considered confidential. Only use a free secure and Hipaa complaint service.
Use the following link to email and send me back your forms in a secure way (MedTunnel) any time. No need to register and free.
**LINK to email us any time and send back your forms.**
NEED TO PAY? PRESS BELOW.
Press here to make a payment:—>$$$* LINK to pay $$$* <—
