Resources

Forms

Prior to your initial appointment, please download and complete the Intake packet (5 pages) and HIPAA acknowledgement form (2 pages). Please bring the completed forms with you to your first appointment.

Intake form

HIPAA form

Release of Information form

Telehealth Informed Consent

Fees and Payment

We accept insurance for payment in most cases. The psychologists in our clinic are in network with most health insurance plans, but not all. Before scheduling your first appointment, you should first check to be sure:

• If you have in-network or out-of-network benefits (which means that you can be reimbursed for seeing a provider who does not participate in your plan)
• What your deductible is
• How many sessions are covered
• Whether you need pre-approval

Most insurance companies reimburse a portion of the fees charged as part of their in- and out-of-network coverage. Check with your insurance provider about your coverage for specific information. You’ll find this described in the behavioral or mental health out-of-network coverage section.

Many individuals choose to pay for services out of pocket rather than through their health insurance benefits. Here are some important reasons for this choice:

• The confidentiality of the work is maintained. Since insurance benefits are not being accessed, no information is shared with them, except with your expressed written consent.
• Treatment plans and goals are developed with you, not a third-party insurance company that may be motivated to cut costs and minimize payments, which may result in ineffectively short treatment. We work collaboratively to decide upon the best course of treatment.

If you do not have in- or out-of-network insurance benefits and are unable to pay the full fee, many of our clinicians may be willing to discuss moderating the fee at the initial consultation.