• banner image

    Checklist & Policies

    When you come to our office for the first time as a new patient, we’ll ask you to complete some initial forms, including an Authorization and Consent for Treatment form which will be sent to you electronically using our digital patient check-in platform Phreesia.

    All required registration and practice forms have to be completed prior to being seen. If we do not have your completed forms on file prior to your visits we may ask you to reschedule your appointment.

    Patient Checklist

    Remember:

    • Upload your insurance card
    • Upload valid photo ID
    • Complete patient registrations forms via Phreesia
    • Submit payment for your co-pay (if applicable)

    For patients who are delayed and arrive late for appointment (virtual and onsite) every effort will be made to see them. However, appointments may need to be rescheduled.

    Office Policies

    Financial Policy (PDF) – This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

    Notice of Privacy Practices (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

    HIPAA Privacy Notice

    New Patient Forms

    Please complete relevant forms before our first meeting. We ask that you give special consideration to the Informed Consent form, which contains important information regarding your privacy, the psychological service offered, and insurance and billing information. Should you have additional questions about our procedures, matters of confidentiality, or insurance and billing, please ask us to clarify. We expect it will take 30 minutes to complete them.

    Quince Orchard Psychotherapy