Forms

Dear Patient,

When you schedule an initial appointment, your primary therapist will be sending electronic intake forms for you to complete prior to your first appointment.

Please complete these forms to the best of your ability. In addition, the following items will be helpful if available:

  • A copy of IEP (Individualized Education Program)/504 (if applicable)

  • A copy of any previous reports and/or summaries by previous psychologists/therapists

  • A copy of any previous psychological evaluations

All the above information will be vital in helping us fully understand you and help us to guide your treatment.

Additionally, all forms must be completed prior to your first appointment in order to promptly submit forms to insurance and check verification of coverage. If forms are not completed prior to first appointment, time will need to be taken from the appointment in order to complete. This will result in using a portion of services time for filling out paperwork, and also there is the possibility you will be held liable for all charges in the appointment as we will not have been able to submit to insurance.

Please contact our office if you have any further questions or concerns.

Sincerely,

Pica & Associates Psychological Services and Holistic Medicine