Child and Family Counseling Center Intake Procedures

This page will explain our intake procedures.  Please call our office to schedule an initial appointment.   Before your appointment, call your insurance company to check on your mental health benefits.  You will want to know before you come in if your insurance will cover part of your visit.     Be sure to ask who manages the mental health benefits, because it may be different from the insurance plan listed on your card. If we are not providers for your insurance, find out if you have any out-of-network benefits. You should ask the following questions and be prepared to provide this information at your intake appointment:  

1) What is my copayment? 2) Do I have to have a deductible to meet before my insurance company will start paying?  If so, how much is it and has it been met?  3) Do I need preauthorization?   4) Is there a limit to how many sessions I can have?   Write down the name of the person you spoke with and the date.  You may need this in case of problems.

Be sure to bring your insurance card to your first appointment.  The secretary will need to make a copy of the card.  If you (or your child) has had prior psychological testing, please bring copies of these reports to the first appointment for the therapist to review.  If you (or your child) has had prior therapy or been prescribed psychiatric medication, it would help us greatly if you can provide us with the names (and addresses or phone numbers if you have them) of prior therapists.   We will need you to sign a release of information so we can contact them should the need arise.  

The following are some of our intake forms, along with information about our practice.  Printing them out and completing them ahead of time will help save time at the initial appointment.  If you fill out our Intake Sheet and email or fax it to us before calling to schedule, this will expedite the intake process.  Be sure to note your insurance information; if you need to use your insurance and we are not providers, we'd like to refer you to iproviders who are if possible.   Print out the Practice Forms for your own records, especially the Office Procedures, which will help you understand how we operate and help make your experience with us a positive one.

Please arrive 5-10 minutes early for your first appointment to give the secretary a chance to check you in, copy your insurance card, and have you sign a financial agreement, as well as other paperwork if you have not printed out and signed them ahead of time.  If you complete the HIPAA forms ahead of time, PLEASE read our HIPAA policies carefully, as they contain important information about the limits of confidentiality.  This form must be signed before your therapist sees you .  Be sure to ask your therapist if you have any questions about confidentiality, particularly if you are brining your child or teenager in.  

If you have any questions, please don't hesitate to call us.  The following forms are all PDF files.  

(For the Release of Information form, please print one out for each person you would like us to contact.  Insurance companies require us to ask that you sign a release for your primary care physician, though you can check the "do not authorize" line if you do not want your therapist to contact your physician.)

Updated: 11-2-11

 

Intake Forms                                                                 Practice Forms

 

Financial Agreement                                                            Office Procedures

 

Patient Registration Form                                                     Guide to Counseling and Psychotherapy

 

Lifetime Payment Agreement                                                Guide to Couples Counseling

 

HIPAA Policy and Consent Form                                         Adolescent Confidentiality Form

                                                                                            (This describes limits of confidentiality for teens;

Release of Information Form                                                    parents and teens should read and sign)

 

Child and Adolescent History Form  OR Adult History Form