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New Patient Paperwork

  1. Registration Form
  2. Consent Form
  3. New Patient Questionnaire
    Page 1 | Page 2 | Page 3 | Page 4 | Page 5 | Page 6 | Page 7 | Page 8
  4. Copy of Insurance Card (front and back)
  5. Copy of ID such as driver's license (front and back)
  6. To send, please use my business email:
    Note: My business email is fully encrypted and HIPAA compliant (I use Paubox, which is HITRUST CSF Certified, the gold standard within healthcare).


Insurance FAQs

Do you Take Insurance?

Yes, I am in-network with several insurance companies:

  • Aetna
  • BCBS
  • BCBS Complete
  • BCN
  • BCN Premier Care
  • McLaren
  • Tricare/Humana Military
  • Medicare

Be sure to check your insurance coverage benefits for Behavioral Services by calling the 800 number on the back of the insurance card to find out the following:

  • Do I have a deductible? How much is remaining for the year?
  • Do I have an out of pocket copay or co-insurance for each session?
  • Does my insurance have a "carve out" for Behavioral Services?

What if my insurance doesn’t cover your services?

Call your insurance company and find out if they provide an out of network reimbursement benefit. Find out if you need a receipt for reimbursement.

If I am not using insurance, what are your rates?

Please call me to discuss this arrangement. My fee is $150 per session.