Alternative Ways of Getting Forms to Us
These methods require you to print or use pdf. filler to complete forms
We require Treatment and Billing Forms before services can begin. Please read all instructions.
Treatment Forms
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For In-Office, Teletherapy or Psych Eval, bring the applicable forms to the first session.
~~~~~~~ Adult or Child Intake Form Notice of Privacy Applicable Consent Form ~~~~~~~~ Email is not confidential. If you choose to email forms to us, it is done at your own risk. You may Fax forms to us at (512) 693-4006 prior to your first session. |
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Payment Forms
Fax or bring the following forms to our office one week prior to the initial in-office, teletherapy or psych eval appointment.
Fax Number: (512) 693-4006
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Required Payment Policy
Easy-Pay Credit Card Policy
Contact Information and Insurance Form
Copy of Photo ID (Teletherapy Only)
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Email is not confidential. If you choose to email forms to us, it is done at your own risk
| full_payment_agreement_rev_1-11-18.pdf |
| credit_card_agreement-letter_head.pdf |
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See instructions below for this form.
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Instructions for printed Contact Info and Insurance Form
Self Pay (Not using insurance):
If paying out-of-pocket, you will only need to fill in the contact information section of the "Contact Information and Insurance Form" . Write in "self-pay" in the Primary Insurance box.
Using Insurance:
If using insurance, complete the "Contact Information and Insurance Form" and "Required Payment Policy" as soon as your appointment is set. Fax the forms to (512) 693-4006 or bring to office a week "before" your first session. If your first session is scheduled within a week, get the forms to our office immediately.
If paying out-of-pocket, you will only need to fill in the contact information section of the "Contact Information and Insurance Form" . Write in "self-pay" in the Primary Insurance box.
Using Insurance:
If using insurance, complete the "Contact Information and Insurance Form" and "Required Payment Policy" as soon as your appointment is set. Fax the forms to (512) 693-4006 or bring to office a week "before" your first session. If your first session is scheduled within a week, get the forms to our office immediately.
Verification of Your Insurance Benefits:
As a courtesy, we will verify your insurance benefits, but only after we receive your insurance information.
Please note that your initial session or other behavioral health service is tentative, pending benefits verification. If there is a delay in benefits verification because we have not received your insurance information, your appointment will be rescheduled or cancelled.
We can be reached at (512) 704-8349 between the hours of 8:30am and 5pm, Monday through Friday. You may email us at [email protected].
As a courtesy, we will verify your insurance benefits, but only after we receive your insurance information.
Please note that your initial session or other behavioral health service is tentative, pending benefits verification. If there is a delay in benefits verification because we have not received your insurance information, your appointment will be rescheduled or cancelled.
We can be reached at (512) 704-8349 between the hours of 8:30am and 5pm, Monday through Friday. You may email us at [email protected].
Thank you for working with us!
