We are committed to your privacy. Please do not include confidential or private information regarding your health condition in this form or any other form found on this website.This form is for general questions or messages to the practitioner.To schedule an individual, group, child, couples, marriage or family therapy appointment or to obtain additional information about any of these counseling services, kindly call us so we can get you scheduled within 3 business days.Intake forms will be sent to your email on file. There is no printing the forms only entering the information and submitting online Partners, spouses and family members may schedule for a loved one provided an active payment method is given at first contact.
Please Note: Some calls are returned evenings and weekends due to the nature of this business.
|Payment options: ALL CLIENTS are responsible for understanding, keeping current and adhering to their HC Insurance policy, along with the obligations that come with it. Most debit and major credit cards are accepted, virtual accounts such as CHIME & some Health Savings Accounts are not. Please note: due to same day cancellations an active
Debit/Credit card link up will be required to schedule your first appointment. Receipts are sent via email provided. Payment is due at time of service. All services rendered in part or whole are non-refundable including those associated with the use of HC Insurance. You are responsible for any unpaid balances shall your insurance
policy not cover a provided service or fail to reimburse us. Clients and their partners/spouses are financially responsible for one another regardless if therapy unfortunately leads to separation or divorce. An active payment method on file along with all intake forms completed and submitted to us is a requirement for continuation of service.
NOTE: We are an expanding community service that has committed the time to contract with as many Insurance panels as possible. This was done so as to offer our services to the general public. Money was not the major factor in this decision. Being as transparent as possible, we strongly encourage potential clients to access the information on our website in order to minimize any expectation gaps that may arise during your first appointment or those after. Compliance of our office policies and Information requests are a requirement for service.
Cancellation Policy: Clients, their partners and their dependents are responsible for any missed, no show or same day cancellations. As a company courtesy, appointment reminder emails are sent out prior to your scheduled session. If you fail to show up to your scheduled appointment and have not notified us at least 36 hours in advance, you will be charged a $90 cancellation fee regardless if utilizing health insurance or any EAP benefits. If you fail to provide an active method of payment at time of service or leave prior to completing your Intake appointment, you will be billed accordingly and your insurance company may be notified. Additional actions may be taken against your insurance policy.
Dispute Policy: if you choose to dispute a valid MBT charge with your financial institution, your Insurance carrier will be notified. Mind Body Therapeutics will not be held responsible for any possible actions taken against the policy subscriber, or one of its beneficiaries afterwards or in the future by a contracted panel. In addition, you will also be held responsible for administrative and collections related charges by a third party.
* Important Scheduling Notice: If you are currently in the deductible phase of your policy, the practice will be required to secure 70% of your contracted payment in order to be added to the clinical session schedule. If you fail to show to your scheduled Intake appointment that amount will be charged in order to cover your time slot. After completing the Intake session this amount will be applied towards your account. Unfortunately, we cannot allow any exceptions!
* Exclusive Telehealth Requests: All requests will be reviewed at first point of contact. ALL Intake forms including a Telehealth Payment Agreement will need to be completed and signed prior to being added to our clinical session schedule.
We are a professional group practice. As such, our staff members, psychologists, therapists and counselors take your time and theirs seriously.
We ask that you please be mindful and responsible as we are at service for you!
Thank you very much!
COVID19 Isolation, Anxiety and Depression
Mental Health Counseling