Most Major Insurances Accepted

*REQUEST MY APPOINTMENT & VERIFY MY INSURANCE FORM 

For all *Prospective Clients and Returning Clients, required form assists us in understanding your treatment needs, ensuring an optimal client-clinician match.  It also captures your scheduling preferences and health insurance information.  Upon receipt of this form, we will promptly provide you with a Benefits Quote and schedule your Intake Appointment accordingly. 

WHAT HAPPENS NEXT?

You'll receive a Welcome Message with:

• Your Intake Appointment Details
• Benefits Quote or "Good Faith" Estimate
• Intake Forms 
• Link to Clinician's Virtual Waiting Room 

To confirm the Intake Appointment, simply reply with "C".

Warm Regards, 

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.