Initial Visit - Intake Forms & Financial Policy:

All forms can be completed prior to coming for the first visit, by creating user id and password (detailed instructions are provided via email after the first appointment is scheduled) or onsite when you arrive for the first visit.

Required Forms:

  • Patient Demographics

  • HIPAA - Notice of Privacy Practice

  • General Consent

  • Financial Policy

  • Adult Intake Form - 18 years of age or older

  • Child Intake Form - (Completed by caregiver) A parent or guardian MUST attend the first session to sign initial paperwork.

Claim Submission:

  • If you want us to submit claims to your insurance your current insurance card is required.

  • We are currently preferred providers for most insurance networks including Medicare and Medicaid providers.

  • Sliding Scales are available by providing proof of income. (pay stub or letter from an employer)

    Feel free to call our office with any questions or concerns regarding your insurance plan.

Fees Policy:

In order to hold the line n the cost of therapy while maintaining a superior level of professional care, payment is expected in full, either by an insurance and/or by clients. The insurance co-pay is due on the day treatment is rendered. Summit guarantees the refund of overpayment to clients on a timely basis.

The following payment options are available:

Cash | Check | Money Order | Visa | Mastercard | Discover | AMEX