We are in-network with Blue Cross Blue Shield PPO, United Healthcare, and Aetna. We also welcome self-pay clients for those utilizing out-of-network benefits.
To help expedite the intake process, please provide the patient’s full name, date of birth, and a photo of the front and back of your insurance card. You may email this information to info@goodingsgrovepsych.com. Once received, we will confirm verification of your insurance benefits by email.
Please complete the eForms below before your first appointment. Any fields left blank will not come through our processing system and will read as incomplete. All fields including credit card information must be filled out for copay or deductibles. The Release of Information Form is optional.
Patient Information Form
Patient Information Form
Informed Consent Form
Informed Consent Form
Privacy (HIPAA) Form
Privacy (HIPPA) Form
Release of Information Form
Release of Information Form
