Helpful forms and payments.
If you're a new client, please complete the following forms and bring them to your first therapy session.
- Intake Form
- Disclosure Statement & Agreement for Services
- Notice of Privacy Practices
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
- Release of Information Form
We may be able to direct bill various insurance companies for you. If your insurance company is not listed below your treatments may still be covered. Check with your individual insurance company.
Current Insurance Partners
- Anthem / Blue Cross Blue Shield of CT
- Empire Blue Cross Blue Shield of NY
- Cigna Behavioral Health
- Husky CT / Medicaid