NEW CLIENT INSTRUCTIONS FOR PAPERWORK

Welcome.  Please read the instructions below for what to do with the paperwork prior to arriving for your appointment.

Please PRINT OUT the following from the links on www.DrErickson.net:
2 Informed Consent Forms
1 Adult Personal Data Inventory Form per adult
1 Child/Adolescent Personal Data Inventory Form per
  child/adolescent
1 Health Insurance Claim Forms(s) (HCFA-1500) per client
1 Assignment of Benefits Form
1 Credit Card Pre-Authorization Form (optional)

INSTRUCTIONS
- Please read the Informed Consent Form, then keep one copy
  for your records and have all adults sign a copy to bring to
  Dr. Erickson
- All clients should fill out an Adult or Child/Adolescent
  Personal Inventory Form (as best you can)
- If we have discussed reimbursement through your insurance,
  fill out and sign, where indicated, one Health Insurance
  Claim Form for each adult/child in therapy, and the
  Assignment of Benefits Form provided
- If you intend now or later to make payment by credit card,
  fill out the Credit Card Pre-Authorization Form

UPON ARRIVAL FOR YOUR APPOINTMENT
- PLEASE BRING all the forms identified above to your first
  appointment
- When we meet, you will also be given a copy of the
  Consumer’s Guide to Marriage and Family Therapy brochure
- PAYMENT
  - if paying by check, please write your check in advance for
    the amount due (if known) to “Dr. Cassandra Erickson”
  - if paying by credit card, please have your credit card
    ready for swiping and authorization at the end of the
    session

I look forward to meeting you soon and will be glad to answer any questions you may have!
Cassandra Erickson