Bring the following completed forms to your initial session:

  • Client Info form
  • Therapy Information and Agreement form
  • CMS 1500 Insurance claim form (if you are planning to use insurance)

If you are planning to use insurance, also bring the CMS 1500 Insurance Claim Form, having completed boxes 1-13. You may leave blank anything you are not sure how to answer. In addition, bring a photocopy of the front and back of your insurance card.

To print and fill out a CMS 1500 Insurance Claim Form, click on the link below:

http://www.fchp.org/NR/rdonlyres/BCC8F41E-50D4-426A-BA30-A916F38C68BA/0/Health_insurance_claim.pdf

Couples: each individual in the couple must complete a separate Client Information Form.

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