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Getting Started with Us

Getting started is a seamless process!  Complete our verification form below and we will begin verifying insurance coverage.  If there are any issues with the verification process, we will call and do our best to find a resolution so you can begin sessions as soon as possible.

New Client Verification Form

 

Please be sure to leave your email and phone number so that we will be able to contact you for scheduling.  Completing this form does not guarantee that you will be scheduled for sessions.  Screening for appropriate level of care is pertinent to the process.  For individuals using insurance, please remember to include your member I.D . We will inform you if your policy requires a deductible or a co-pay.   Co-pays amounts are outlined in your contract with your insurance company and are REQUIRED by federal law to be collected.  Co-pay charges and deductibles are not optional as outlined by the agreement you made with your insurance carrier.  Co-pay charges and deductibles cannot be billed to a client's account.  They are required by law to be paid at the time of service.

If you have any questions, please feel free to reach out to us at (912) 737-2176.

Full Name*

Date of Birth*

Parent/Guardian Name (If Applicable)

Phone Number*

Email Address*

Street Address*

Gender*

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Preferred Therapist *

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Therapy Service*

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Service Location*

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Insurance/Payment Method*

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Insurance Member ID

Brief Reason for Seeking Services*

Questions/Concerns

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