You're in great hands
I do my best to make my new clients feel comfortable. During your first visit, I will get some background information to help me better serve you. From there, we will work together on how I can best support you. I realize life schedules can be challenging, so I will always do my best to be flexible and meet your scheduling needs.
To get a head start, please fill out the following new client forms and email them to me or bring them with you to your first visit.
Service Agreement
Fee Schedule
HIPAA Privacy Practice Notice
HIPAA Acknowledgement of Privacy Practices
Electronic Communication Consent
Credit Card Form
Release of Information (If you would like to give me permission to communicate with someone)
Additionally, a Good Faith Estimate will be provided to you based on your personal information.
Insurance:
Chapel Hill Family Counseling, P.C. is an out-of-network provider. I will provide you with electronic statements that describe the nature and dates of clinical services rendered, and you may submit these to your insurance carrier for the purpose of seeking out-of-network reimbursement according to your insurance carrier.
Have any questions?
Use this form to get in touch. I will get back to you in 1-2 business days.