CUSTOMIZED BEHAVIORAL HEALTHCARE
Home
About Us
Services
Staff Directory
  • Dr. Anthony Rivers, Psy.D
  • Dr. Essence Rivers, Psy.D
  • Dr. William Hanna, Ph.D.
  • Kelley Boyce, LISW
  • Alicia Daniels, LISW
  • Colleen Rivers, MA
  • Whitney Cooney
Connect
Intake Forms
Blog
School Services
Customized Tutoring
Contact Us
CUSTOMIZED BEHAVIORAL HEALTHCARE
Home
About Us
Services
Staff Directory
  • Dr. Anthony Rivers, Psy.D
  • Dr. Essence Rivers, Psy.D
  • Dr. William Hanna, Ph.D.
  • Kelley Boyce, LISW
  • Alicia Daniels, LISW
  • Colleen Rivers, MA
  • Whitney Cooney
Connect
Intake Forms
Blog
School Services
Customized Tutoring
Contact Us
More
  • Home
  • About Us
  • Services
  • Staff Directory
    • Dr. Anthony Rivers, Psy.D
    • Dr. Essence Rivers, Psy.D
    • Dr. William Hanna, Ph.D.
    • Kelley Boyce, LISW
    • Alicia Daniels, LISW
    • Colleen Rivers, MA
    • Whitney Cooney
  • Connect
  • Intake Forms
  • Blog
  • School Services
  • Customized Tutoring
  • Contact Us
  • Home
  • About Us
  • Services
  • Staff Directory
    • Dr. Anthony Rivers, Psy.D
    • Dr. Essence Rivers, Psy.D
    • Dr. William Hanna, Ph.D.
    • Kelley Boyce, LISW
    • Alicia Daniels, LISW
    • Colleen Rivers, MA
    • Whitney Cooney
  • Connect
  • Intake Forms
  • Blog
  • School Services
  • Customized Tutoring
  • Contact Us

INTAKE FORMS

COMPLETE THE INTAKE & PERSONAL HISTORY FORM IN ONE OF TWO WAYS


1. In advance
Simply complete the forms (below) at your convenience.
Then bring them to your first appointment.


2. At your first appointment
Plan to arrive 10 to 15 minutes early to complete these necessary forms. 

Intake forms

Client Background Form (pdf)Download
Consent to Treatment (pdf)Download
Notice of Privacy Practices (Brief-Version) (pdf)Download
Financial Agreement Form (pdf)Download
Late Cancellation and No Show Policy (pdf)Download

Authorization Forms

Customized-Behavioral-Healthcare-Authorization Form (pdf)Download
Customized Behavioral Healthcare-Client and Parents Release Form (pdf)Download

USING INSURANCE TO HELP PAY FOR COUNSELING?

 

Questions to Ask Your Insurance Provider


Concerning Mental Health Benefits
*Do I have behavioral/mental health coverage?
*How many outpatient psychotherapy sessions am I allotted in my plan?
*Are there any limitations, requirements, or restrictions in accessing my plan?


Additional questions for more detail:
Do I need a referral from my Primary Care Physician?
Do I need to have pre-authorization from my insurance company?
Is my therapist in your network? If not, what are my out-of-network benefits?
Am I authorized to see only a particular kind of therapist? (psychiatrist, psychologist, licensed mental health counselor, licensed marriage and family therapist, licensed clinical social worker, etc.)?
What is the effective date of my insurance coverage?
Am I limited to a dollar amount per year ($500, $250 etc.) that will be covered?
What is the amount of my deductible, co-pay, and co-insurance amounts after insurance adjustment is applied?

  • Home
  • About Us
  • Services
  • Blog
  • Contact Us
  • Resources

CUSTOMIZED BEHAVIORAL HEALTHCARE

Copyright © 2023 CUSTOMIZED BEHAVIORAL HEALTHCARE - All Rights Reserved.

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept