Forms
Welcome to my practice! I’m glad you found me. I look forward to helping you heal and
be well. You have taken an important step by reaching out for help. Thanks for calling and making an appointment.
If possible, please print and complete these forms to the best of your ability prior to our first appointment. Bring them with you to our appointment, or I can have some ready for you in the office that you can fill out in advance.
I accept self-payment.
I can provide an invoice for out of network reimbursement.
Out of Network: Aetna, Cigna, Humana, Medicare, United Healthcare, Anthem Blue Cross Blue Shield (including Federal Employees), Government Employees Health Association and MultiPlan, etc.
I accept credit or debit cards that we process via the Ivy Pay app.
I’ll see you soon.
Lisa
| no_surprises_act_notice.pdf |
| consent_for_treatment_form.pdf |
| intake_form_2023.pdf |