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Forms for New, Current, and Returning Patients

Please print and fully complete all forms to bring with you, along with your insurance card, to your appointment.

*** Important: please note that our office staff does not verify patients' insurance benefits prior to initial consults/first appointments. Instead, we kindly ask that you call your insurance company to obtain information regarding your benefits prior to your arrival at our office. Doing so will ensure you are able to maximize the time allotted for your respective appointment window.

Registration Form

Insurance Verification Form

Adult History Form

HIPAA Acknowledgment Form

Child/Adolescent History Form

We regret that we are unable to accept Humana Insurance, United Healthcare Insurance, and Cigna Insurance.

For those individual who can file for out-of-network benefits, our billing department will be more than willing to provide you with a copy of your superbill.

If you are unable to access any of the forms, please don't hesitate to call our office.

Germantown Psychological Associates, P.C.

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