Below are the forms which we’ll need to begin the therapy process.

Please fill out, sign and return the forms below:

•    Acknowledgement of Receipt of Privacy Practices
•    Informed Consent
•    Consent for Tele-Mental Health
•    Intake
•    Electronic payment Authorization (for your fees and co-pays). Please note that there are 3 ways to pay your fees on the form. 

Print and keep the Privacy Practices sheet:

• Privacy Practices sheet.

Also, please send me a copy of your insurance card if you have Cigna insurance ONLY.   I do not bill any insurance other than Cigna. 

All forms can be emailed to me at LeanneHart@mac.com.