Most Major Insurances Accepted
*APPOINTMENT REQUEST & INSURANCE VERIFICATION FORM
For all *Prospect Clients and Returning Clients kindly complete and submit this 5-7 minute form that assists us in understanding your treatment needs, ensuring an optimal client-clinician match. It also captures your scheduling preferences. Upon receipt of form we'll swiftly provide you with a **Benefits Quote** and arrange your Intake Appointment based on your preferences.
After reviewing your Benefits Quote and ensuring it fits within your budget, please fill out the requisite Intake Forms and Assessments to move forward with our service approval process.
You will receive a Welcome Message containing:
- Your Benefits Quote or 'Good Faith' Estimate
- Date & Time of Your Intake Appointment
- Intake Forms
- Link to Our Virtual Waiting Room
To CONFIRM the Intake Appointment, simply reply with "C".
Melissa E. Mendoza, LMSW
🔗LinkTree Link: https://linktr.ee/pinkpsy
*If not a match we will provide referrals (sometimes we have to refer prospect clients out if schedules can not coordinate, not a good match, if you are to closely related to a current client and there is a conflict of interest, present to need a higher level of care, due to mental health carveout, from medical insurance, to a third party insurance wherein we are NOT in network with the mental health carveout, ect.).
**No obligation or cancellation fees if you decide not to proceed with the session based on the provided benefits quote.
***All Forms are Mobile Friendly / Electronic Forms that are HIPPA compliant and ENCRYPTED which means your information is safe and secure.