📌 Pro Tip: Before filling out this form, take clear photos (front & back) of your insurance card and driver’s license. Then, complete this form on your phone for easy upload when prompted.

Please fill out this required form as it helps us understand your needs, helps with best client-clinician match, and is used to gather your scheduling preferences and insurance details; thank you. 

What Happens Next?

Upon form submission, you’ll receive a Welcome Message with the following:

✅ Your Benefits Quote – A breakdown of your cost per session.

📅 Your Intake Appointment Details – Includes your Intake Session Date & Time based on your noted scheduling preferences. 

📝 Your Electronic Intake Forms & Assessments – Complete these 24-48 hours before your first session to ensure a smooth start.

🔗Virtual Waiting Room Link - A direct link to your clinician’s Virtual Waiting Room. Just click and join at your scheduled Intake Appointment time—no extra setup needed!

Thank you,

Melissa E. Mendoza, LMSW

Pink Positive Psychology

🔒 Your Privacy Matters:  Our mobile-friendly, HIPAA-compliant, encrypted forms keep your personal information safe & secure.