Welcome!

Current Insurance information

 

I can bill most insurance as an out-of-network provider.  Please check your benefits with your insurance carrier.

 

I am currently a preferred provider for the following health plans:

 

  • Aetna

  • Blue Cross/Blue Shield

  • Bridgespan

  • First Choice Health

  • Healthcare Management Administrators (HMA)

  • MODA

  • PacificSource

  • Regence BC/BS

Forms

 

Here are all the forms you may need to complete before seeing me.  You are welcome to print them out and complete them at home prior to our session, and they are available in the office if you prefer.  If you would like to complete forms in my office, please let me know and plan to arrive 20 minutes early so we can use your whole session getting to know each other.

As a Licensed Professional Counselor in the State of Oregon (License #C2420), I would like you to have my Professional Disclosure Statement.  It tells you about my qualifications, the ethics I adhere to as required by my licensing board, and some basics about my practice.  Please feel free to ask me additional questions if you would like to know more about me.

 

My Privacy Practices gives you information about how I comply with HIPAA regulations when sharing information with other people involved in your care. 

 

Prior to beginning work together, each adult client must sign an Informed Consent.  Parents or guardians must sign the Informed Consent (Child) before I begin working with a child or adolescent.  This form gives you information about the risks and benefits of therapy as well as payment information.  Please also complete the Fee Agreement, which is how you can provide information about any insurance you would like me to bill.

 

It is helpful if you complete a brief questionnaire about why you are seeking services.  If you are an adult or adolescent seeking services for yourself, please complete the Adult Questionnaire; if you are a parent seeking services for your child or adolescent, please complete the Child Questionnaire.

 

If you would like me to coordinate services with other providers, such as a doctor or teacher, please complete a Release of Information form.

© 2017 by Patti Bear