New Client & Policy Forms:
PLEASE BE SURE THAT ALL NEW CLIENT PAPER WORK IS COMPLETED BEFORE COMING TO YOUR APPOINTMENT. IF YOU CAN NOT COMPLETE IT BEFORE, PLEASE ARRIVE 30 MINUTES PRIOR. THANK YOU!
Pathways to Wellness has made new client paperwork available online.
The forms provided below must be completed and brought with you upon your first session with your therapist. Completing these forms at home will save you the hassle of coming in earlier than your appointment time, minimizing the time you spend waiting in the lobby.
Should you have any questions regarding these forms, please contact our office at 714-432-9856, Ext 100 or firstname.lastname@example.org
- Notice of Privacy Practices
- Office Policies and Procedures
- Acknowledgment of Receipt
- Consent to Disclose
- Assignment of Benefits
- Client Information Questionnaire
- Authorization to Treat Minor
- Family and Child Development Questionnaire
(Note: Only forms 3-8 must be returned to Pathways to Wellness)
At Pathways to Wellness, we are OUT-OF-NETWORK for all insurance companies, meaning none of our therapists are a preferred or contracted provider with any insurance company at Pathways to Wellness.
We will gladly bill most major insurance companies, as a courtesy to you, if you have a PPO or a POS plan with out-of-network benefits.
We cannot bill HMO plans as HMOs have their own providers and will not pay out-of-network providers.
We do accept Medicare with supplemental insurance. Current therapists accepting Medicare with supplemental insurance are Stephenie Champlin LCSW.
Since the scheduling of an appointment involves a reservation of time specifically for you, a minimum of 24 hours notice is required for rescheduling or cancelling appointments. The standard session fee will be charged for any missed sessions without such notification.
Clients who miss appointments, and fail to inform the office 24 hours prior, are required to pay for missed sessions and for future sessions in advance in order to secure desired appointments.