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Reflect
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Forms
Please read and sign the HIPAA Notice and Informed Consent for Treatment prior to our first session. If you plan to use Blue Cross Blue Shield PPO insurance or Magellan Medicaid insurance, please read and sign the insurance paperwork. If you plan to use Out-of-Network insurance benefits, please inform me prior to our first appointment.

If you do not have access to a printer, I will be able to provide a copies of forms for you at our first session. You are also welcome to fax these forms to me prior to our first appointment through my secure fax line at 1-888-975-0604.

Thank you!
Informed Consent for Treatment.pdf
click to download
Telehealth Consent.pdf
click to download
BCBS Release and Information_1.odt
click to download
HIPAA Privacy Notice.pdf
click to download