We Bill Most Insurances

More Information: www.CrisisCounseling.com
 

Bend Psychological Services
965 NE Wiest Way
Bend Oregon, 97701
Office: 541 388-5660
FAX: 541 388-4638

How To Become A Client or Patient - 4 Steps

Step 1.  Please print, read and sign the following  forms when indicated. Bring all these forms to your appointment. Contact us if you have any questions.

INFORMED CONSENT AND SERVICE AGREEMENT (PRINT)

Informed Consent Acknowledgement (PRINT & SIGN)

Step 3Please print, read and bring the following forms to your first appointment. 

Contract for Services

Step 3 Please print this form and bring it to your appointment

Information Release forms

Step 4If asked, please complete our Background and Information form. Please complete this form by hand or on-line. You may submit on-line, mail, or bring it to your first appointment. 

Adult: 

Child/Youth:

Policy.  We can seek re-imbursement from their insurance in most cases. We can bill insurance companies directly for  you. In some case we offer reduced fees or a sliding scale.  Please read: The Impact of Using Health Insurance