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.
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