New Client Forms

New Client Intake Forms

• Client Agreement
• New Client Intake
• HIPPA Policy

Optional Forms

• Consent to Exchange Form
• Consent to Release Form

Instructions for New Clients

You can save time filling out forms during your first office visit by printing and filling out the documents listed under "New Client Intake Forms" above. Please fill out the "New Client Intake" Form and "Marital Questionnaire". The HIPPA Policy and Client Agreement are important informational documents for your own use and are for you to keep. Please sign the last page and return to us in your first session. Your therapist will be discussing the documents with you during your first visit, and will be happy to answer any questions you have at that time.

The optional forms, the Consent Forms, are to be filled out only if you wish for your therapist to communicate with another care provider or professional, such as your medical doctor, prior therapist, or psychiatrist.

We will gladly discuss fees prior to making an initial appointment and provide a detailed fees policy before your first session. As an added service to you, we accept and will file for BCBS NC.  As a result of the complexity involved in filing insurance for you, we would like to remind you of the following:

1.) While we check your benefits for you as a courtesy, it is ultimately your responsibility to be informed, stay informed, and communicate with us about your insurance benefits. We recommend that you call your insurance company yourself before your first visit and check your mental health benefits.

2.) Your benefits are not guaranteed until claims are filed on your behalf and your insurance pays on those claims. It typically takes four to six weeks after your first session before your insurance pays on the claims and sends us a final explanation of your benefits.

3.) We are only as accurate as the information your insurance company gives us. Occasionally, insurance companies gives us inaccurate information about co-pays, deductibles, session limits, etc. We are required to charge you what they tell us to charge you. If you believe there has been an error in your benefits, it is your responsibility to address the problem with your insurance company and to pay your My Therapist bill in a timely fashion. My Therapist is not financially responsible in the event of a disagreement between what you thought your insurance would pay and what they end up paying.

4.) While we do our best to keep track of session limits, it is also your responsibility to be aware of how many sessions you insurance company allows per year, and to keep track of how many sessions you are using at My Therapist and with other mental health providers such as psychiatrists. Your therapist has no way of knowing how many sessions per year you have used with other mental health providers, and thus, it is ultimately your responsibility to be aware of when you have used up all your sessions for the year.

5.) It is your responsibility to inform us when your insurance benefits have changed for any reason. Many insurance policies change on a yearly basis, and while your insurance carrier might not change, the number of sessions per year or your deductible could change. Please call and check your benefits at least once a year and inform us of any changes.