I am an out-of-network provider for insurance companies not listed below. If your plan allows you to use a provider of your choice then I will bill on your behalf. Please find out if your insurance will cover my services and what your deductible and co-pays are before your first session. That will greatly ease our work together.
I am on the panels of:
United Behavioral Health
Pacific Care Behavioral Health
Blue Shield MHSA as managed by Magellan
Ann Clark Associates (ACI)
Victim Witness Program
Reliant Behavioral Health
Managed Health Network
Anthem Blue Cross
For some insurances I will also be providing EAP services.
These following forms must be completed when we start our work together. You can come 15 minutes early and fill out these forms in my office if that is easier for you or you can read and print them out at home and come with them completed.
1. This form gives the basic Information I need about you:
Most will not need to fill out the following forms:
Print and sign the Consent for Assessment form only if you are going to come for an initial consultation as a person not planning on using insurance. If you use this form then you don't yet have to read or sign the Consent for Treatment or Release of Information forms at this time.