For new referrals and new patients, please complete our INSURANCE VERIFICATION FORM. Once your insurance is verified and you receive an email from DCS, please go on to complete our CONSENT TO TREAT/CONFIDENTIALITY, NEW PATIENT QUESTIONNAIRE , and the CREDIT CARD AUTHORIZATION FORM and email them back to firstname.lastname@example.org
Your credit/debit card will ONLY be used to cover any of your co-payments and any no-show/cancellation charges.
($75 charge for no-shows or appointments that are canceled inside the 48-hour notice cancellation policy).
We will have your insurance verified within 24 hours.
THESE ARE WORD DOCUMENTS SO THERE IS NO NEED TO PRINT ANYTHING. JUST FILL THEM OUT, SAVE THEM & EMAIL THEM BACK TO US
If there are forms that require a signature, you can print them, sign them, take a picture of the form and email it to us.
Also, if you are looking for anyone to be part of your treatment or informed about your progress (family, employer, courts, etc.) we ask that you please sign our RELEASE OF INFORMATION TO 3rd PARTIES and email it back to us.
All forms are confidential and we use a HIPAA-compliant email system.
Our office is now open for in-person sessions.
09:00 am – 05:00 pm
Evening and other off-hour sessions can be scheduled by appointment only (will most likely be virtual sessions)
premier boutique counseling and therapy on cape cod, massachusetts. Copyright © 2021 Donlan Counseling Services - All Rights Reserved.