´╗┐

INSTRUCTIONS:
Please click each link below to complete these forms; give yourself 45 minutes to complete your online paperwork. Please review your information prior to submitting.

Demographic Questionnaire
Intake Form
´╗┐Informed Consent
Notice of Privacy Practices
Release of Information Form (DO NOT submit)

Planning Your Visit (please review prior to your visit)

* If applicable, your co-pay or co-insurance or deductible will be due at the end of each session; using your health insurance is not a guarantee of payment for services rendered. For all your billing questions and inquiries please contact Express Billing Solutions at 317.804.9035.

* Discount up to 20% offered if you pay for services out-of-pocket; sliding scale fee is not offered at this time. * Cash, check, or credit cards are accepted as a form of payment.

 Mental Health Bill of Rights
 
NorthStar Psychological + Consultation Services, LLC
429 E. Vermont Street
Suite 307
Indianapolis, IN 46202
Phone:
317-572-7847 (ST4R)
Fax:
317-632-3253
eMail:
info@northstarpsych.com
Hours:
Monday 3:00 pm to 8:00 pm & Tuesday through Thursday 8:00 a.m. to 8:00 p.m. Closed all other days.