While we try to keep our forms to a minimum, for your convenience, here are our standard forms that you might find helpful to review before, rather than during your first appointment.
Informed Consent
| informedconsent_2-23-2019.pdf |
HIPAA Privacy Practices
| hipaanoticeofprivacypractice.pdf |
Client Rights
| hipaaclientrights.pdf |
Fee Schedule
| feeschedule02-01-2020.pdf |
Consent Relationship Counseling
| informedconsent_marriage-couples_counseling08-18-2019.pdf |
INSURANCE Our in network contracts include Anthem, Med Mutual, Cigna, CareSource, Medicaid, Buckeye, and Medicare*. Other insurance plans are accepted on an out-of-network basis. We also accept self-pay. Our fee schedule can be found on the Intake Forms page. (*Medicare insurance holders may be limited to those clinicians that are eligible to bill Medicare. Please ask before scheduling an appointment if your therapist is credentialed with your insurance.)