Our office is no longer going to be accepting insurance as payment beginning in June 2017.
You may still use your insurance and we will assist you with a super bill for submission to your insurance company for direct reimbursement.
We will request that you pay for services at the time of your appointment. Please see the Fees page for detailed information.
Forms to Read and Complete First
READ (no need to print) before your first appointment:
- Fill Out, and Sign the following before your first appointment:
You may email any of the above documents to FredPeipman@gmail.com if you prefer. If you are unable to print, I will have a copy of the Privacy Practices Signature page for you to sign but you must read it first.
Optional/Additional Forms and Items:
- Teletherapy Informed Consent-Signature Page Only (print and sign)
- Release of Information Form (Please print and sign if you wish us to share information with someone)
- We can provide you with a "super bill" which you can submit to your provider for direct reimbursement.
- Many of our clients have had good success with Better, a service that makes it simple for you to get paid back for your out-of-network claims getbetter.co
- You will be required to pay for your session up-front (at the time of service)