Welcome to
Full Circle Psychology
and the teachings of Yoga Nidra (iRest)


Insurance Information & Forms to Fill out at Home


Be aware of what it means to use managed care in therapy. For a good article go to www.zurinstitute.com   http://www.zurinstitute.com/bewaremanagedcare.html


Insurance Information


If your insurance company is listed below then I will bill on your behalf as I am contracted to provide services for them.

I am an out-of-network provider for insurance companies not listed below. If you have out-of-network benefits you can work with me.  I will provide you with a superbill so that you can retrieve money from your health insurance company for services received.

Before our first session, please find out if your insurance will cover my services and what your deductible and co-pays are. That will greatly ease our work together.

I am on the panels of: (I am in the process of getting off some insurance panels so you might still see me listed on their websites)

Medicare
Victim Witness Program
Prime
Anthem Blue Cross

Tricare


Paperwork

These following forms must be completed when we start our work together. You can come 15 minutes early and fill out these forms in my office if that is easier for you or you can read and print them out at home and come with them completed.

1. This form gives the basic Information I need about you:


Client_Information_Face_Sheet_Updated.doc
26.0 KB



2. This information (you do not have to print) spells out all you need to know about our contract together. It is the Informed Consent:

Informed_Consent_to_Psychotherapy.doc
152.0 KB


3. Please print, initial and sign. We will go over this material together the first time we meet.

Consent_to_Treatment_Signature_page.rtf
3.8 MB


4. Please read the following  pages (you do not have to print these) about your privacy rights.

California_Notice_of_Privacy_Practices.doc
42.0 KB



5. Please print and sign. It shows that you have read the California Privacy Rights and also that you give a release to allow me to bill your insurance company, if applicable.

California_Notice_Form_and_Health_Insurance_Release_Signature_Page.doc
125.0 KB


6. Please print, initial and sign.

Courtesy_Agreement_Updated.doc
124.0 KB





 













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