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WELCOME!

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NEW CLIENT ON-BOARDING

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START HERE:  Please fill out An Appt. Request & Insurance Verification Form

Getting Started: Get Involved

PRO TIP:  Take Pictures of Drivers License/ID (front & back) & Health Insurance Card/s (front & back) BEFORE filling out this form. 

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*Request My Appointment & Verify My Insurance Form

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This *required form is for Prospect Clients & Returning Clients to gather basic information such as reason/s for seeking treatment to determine Client-Clinician Match; Preferred Days/Times for Therapy Session/s, and Health Insurance/Private Pay Information. Please submit this form so we may promptly provide you with a Benefits Quote / "Good Faith" Estimate and schedule your Intake Appointment according to your preferences.

 

What Happens Next? 

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You'll receive a Welcome Text Message with:

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

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Warm Regards, 

Melissa E. Mendoza, LMSW

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🔗LinkTree Link:  https://linktr.ee/pinkpsy

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*If not a match we will provide referrals.

**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.

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                                                                                  About                                  Legal

                                                                                  Contact Us                         Good Faith Estimate

                                                               Services                              Privacy Policy 

                                                                                  Rates & Insurances           Terms & Conditions

                                                                                  Virtual Visits                       Communication Consent

                                                                                  Blog                                     HIPPA Privacy Notice

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In An Emergency: 

If you feel that you may be of harm to yourself or someone else

please call 9-1-1 and go to the closest emergency room.

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Crisis Resources:

988 Suicide & Crisis Lifeline

www.988lifeline.org

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The 988 Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States. 

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Simply Need Extra Support:

If you need more emotional support after you already have had your scheduled appointment for the week, you are welcome to schedule a second appointment for the same week.

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