NEW CLIENT PAPERWORK
Our time together is short and I want you to get the most of it. Please take a few minutes to print, read, complete and sign the following forms before our initial session together.
Consent Forms: please print one copy. I will go over these forms with you in our first session.
Medical Provider Communication Form: please print one copy for each client.
Biopsychosocial History: please print one copy for each client.
HIPAA Privacy Practices: please read and print a copy if you would like a paper copy.
Release of Confidential Information: if you would like me to communication with other individuals or agencies, please complete this form.
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Frequently Asked Questions
+ HOW DOES THIS WORK?
A common question I get from those looking for help is "how does this work?" I say "it's pretty easy!"
- If you plan to use insurance, check to see if I am in your network. Also verify copays and/or deductibles.
- Call or use the link below to schedule an appointment time.
- Print and complete the paperwork listed above.
- Come to the appointment.
+ WHAT'S THE INVESTMENT?
Both self-pay and insurance reimbursement are accepted as payment. Our first session is 60 minutes. All subsequent sessions are 45 minutes in length.
Fees for sessions are as follows:
$120 for the initial session $90 for each subsequent session.
Payment is due at the time of service. Cash, personal checks, credit and debit cards are accepted.
+ DO YOU ACCEPT INSURANCE?
I am in-network with the following insurance panels and EAP Networks:
- Amerigroup (Kansas Medicaid)
- Blue Cross Blue Shield
- Cenpatico/Sunflower (Kansas Medicaid)
- Mines & Associates
- United Healthcare Community Plan (Kansas Medicaid)
- United Healthcare Commercial Plans
+ WHAT DO I NEED TO KNOW IF I USE INSURANCE?
When deciding to use your insurance, please keep the following in mind:
Insurance companies cover services that are deemed "medically necessary"
Insurance companies can determine the number of sessions a client can receive, how frequent sessions can be held, the format of sessions and at times require documentation from your case file. This means your personal information may not be kept private and others may view your information. Some insurance companies may share your personal information with other companies which could affect your ability to obtain coverage in the future and could also affect the rates you pay for coverage.
+ WHAT'S THE CANCELLATION POLICY?
Your appointment time is reserved especially for you. If you are not able to attend your appointment, a 24-hour notice is required for all cancellations. This will allow other clients to receive services. If a 24-hour notice is not given, a fee of $40 will be charged for the missed appointment and will be due at the beginning of the next session. Since there are times when emergencies arise and 24-hour notice is not possible, I allow for one missed session without charge. All sessions after the missed session will incur a fee. Insurance companies do not pay for missed appointments; therefore this charge will be the client or guardian’s responsibility. Failure to give adequate notice more than three times may result in care being terminated.