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
| feeschedule01-01-2022.pdf |
Consent Relationship Counseling
| informedconsent_marriage-couples_counseling08-18-2019.pdf |
INSURANCE Our in network contracts include Anthem, Med Mutual, Cigna, TriCare/Humana Military, Aetna, 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.) Some services may not be covered by insurance or we do not accept insurance. Please consult with us about any questions regarding insurance before starting services.