Below is the information I need filled out and signed to proceed with scheduling an initial session. In-Person only individuals need not fill out the Telehealth Informed Consent.
2023 Telehealth Informed Consent
CMS – 1500 (only fill out top half, up to and including 2 signatures)
Photo ID such as Driver’s License
Photo of the front and back of Insurance Card(s)
The information below is for your reference and need not be returned