Policies and Agreement form (to download and sign) --.doc format
Payment for Services
Insurance Coverage for Services
I do not accept direct insurance payment for services and does not participate in any insurance provider network.
My services are covered by most health insurance plans that cover out-of-network providers. It is the responsibility of the client to communicate directly with his or her insurance company regarding coverage or reimbursement issues
Monthly statements, appropriate for submission to insurance companies, reflecting all charges, payments, diagnostic codes, and procedure codes, are provided. These statements can be mailed to the address provided or emailed to you.
Payment can be made by check, cash, or credit card (Visa, MasterCard, Discover, or American Express).
Cancellation Policy:
Appointments must be canceled more than 24 hours in advance, except in the case of true emergency. In the event that I am able to fill this time with another appointment, you will not be charged for a last minute cancellation.
Insurance Coverage for Services
I do not accept direct insurance payment for services and does not participate in any insurance provider network.
My services are covered by most health insurance plans that cover out-of-network providers. It is the responsibility of the client to communicate directly with his or her insurance company regarding coverage or reimbursement issues
Financial Statements
Monthly statements, appropriate for submission to insurance companies, reflecting all charges, payments, diagnostic codes, and procedure codes, are provided. These statements will be mailed to the address provided, unless you request otherwise.