Disclosure & Intake Forms

PRELIMINARY PAPER WORK TO FILL OUT BEFORE FIRST VISIT

Thank you for choosing Maine Counseling & Consultation LLC. for your mental health needs. Please note that there is only one intake form to fill out and sign. ( 2 pages). However, Linda and Leo have different Office Policy and Procedure forms. They are clearly marked. Please read them carefully and sign the form and bring it along with the intake form at your first visit.

Eight years ago, Leo resigned from all the insurance panels and therefore he will give you a Super-Bill for every visit which will list all your insurance numbers procedure codes and all his identifying numbers for you to submit to your insurance company for reimbursement. Please check with your insurance carrier to see if you have out of network benefits. Full fee for Leo and co-pay for Linda is collected at each session

Linda is still on a few insurance panels and although we both have the same philosophy when it comes to dealing with insurance companies, due to the uncertain health care climate, (Obamacare, insurance reforms etc. procedure codes and the fact that each policy is different and belongs to you) she is maintaining a relationship with some of the more reasonable companies.

Please feel free to ask us about any of the above.

Client Intake Information