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Click here to download Referral (non-Medicaid)
Click here to download Medicaid CMN
Parents, please download and complete the following forms
prior to your first visit:
Click here for Required Forms to be Completed
PAYMENT FOR SERVICE IS DUE WHEN SERVICE IS RENDERED.
Acceptable methods of payment are:
cash, check, credit/debit cards through Pay Pal at our office. Pay Pal will process: Visa, MasterCard, Discover and Electronic Checks. Effective September 1, 2011, we will no longer file insurance, however we will provide
you with the necessary documentation and assistance to submit your claim to your insurer. We do NOT participate in MS-Can or CHIPS We
are a Medicaid provider
Our HIPAA Policy - 'A Must Read'
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