COMPLETE THE INTAKE & PERSONAL HISTORY FORM IN ONE OF TWO WAYS
1. In advance
Simply print and complete the two main forms (below) at your convenience.
Then bring them to your first appointment.
2. At your first appointment
Plan to arrive 10 to 15 minutes early to complete these necessary forms.
USING INSURANCE TO HELP PAY FOR COUNSELING?
Questions to Ask Your Insurance Provider
Concerning Mental Health Benefits
*Do I have behavioral/mental health coverage?
*How many outpatient psychotherapy sessions am I allotted in my plan?
*Are there any limitations, requirements, or restrictions in accessing my plan?
Additional questions for more detail:
Do I need a referral from my Primary Care Physician?
Do I need to have pre-authorization from my insurance company?
Is my therapist in your network? If not, what are my out-of-network benefits?
Am I authorized to see only a particular kind of therapist? (psychiatrist, psychologist, licensed mental health counselor, licensed marriage and family therapist, licensed clinical social worker, etc.)?
What is the effective date of my insurance coverage?
Am I limited to a dollar amount per year ($500, $250 etc.) that will be covered?
What is the amount of my deductible, co-pay, and co-insurance amounts after insurance adjustment is applied?