HOW DO I GET STARTED?
Let's learn more about you. Here is the initial paperwork needed once you have officially made a time to meet with Deirdre. These forms must be completed well before the first therapy session.
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If you are planning to use health insurance please call the number on the back of your card and check your benefits:
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Ensure with your insurance that you have the following:
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Behaviorial Health / Mental Health Benefits on your plan
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that New York Medical Behavioral Health Services, P.C. is included in your plan
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Tell your insurance that the TIN# is 832675429
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Tell your insurance that the NPI# is 1558604009, Provider: Deirdre Eberhart
Step 1: Fill out the Intake Packet. It is preferred you fill out the electronic signature copy but if there are glitches or you are having trouble - feel free to print, fill out, sign and either bring in or send through the secure portal below (or fax to number at bottom of the page). An Emergency Release Form is already included in this packet, but if you want to sign another one there is an option below to do that, as well.
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Any other releases that need to be filled out for psychiatrists, spouses, parents, financially responsible parties must be filled out separately under HIPAA Release Form. If anyone wants to speak with your therapist at all - there must be a release and you may specify "need to know," "emergency only" or "full/open release."
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Step 2: Please download and fill out the Questionnaires and bring them with you to the first therapy session.
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If you are NOT using insurance please contact Deirdre and submit your financial information (debit card). You may skip all of the following steps if you are paying privately and not using insurance.
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Step 3: If you are using insurance please send a copy of the front and back of your insurance card through the HIPAA Compliant Secure Portal below.
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Step 4: If you are using insurance please fill out the Headway/Alma Agreement.
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Step 5: Once Deirdre has put your information into Headway or Alma (billing companies) you must check your email and fill out the paperwork for billing. This last step should be straightforward and fast. Please check spam folder if you do not see the email - or contact Deirdre.
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Please contact Deirdre with any issues or concerns regarding this paperwork.
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You will get a reminder for your first appointment the day before your appointment. If you choose Telehealth then Deirdre will send you a link the day before, along with a reminder. Your first appointment will consist of a one hour long mental health assessment and all following sessions will typically be one hour.
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FORMS
Electronically Sign the Forms Below
If you have an intake with Deirdre please fill out and sign the forms below before your first appointment. These forms will be sent directly to Deirdre through the secure portal.
EMERGENCY RELEASE FORM
This form should be downloaded and filled out for each person whom you want me to be able to share and receive information from. Please download this form if you have an intake with me and fill this out for your any person who may be paying for your therapy, any doctors you may want me to contact, if you are changing your emergency contact person, and fill it out for your health insurance/EAP you are utilizing for therapy. This form will need to be downloaded and filled out for each individual you want a release for.
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This form was included in the Intake Packet for your emergency contact. Download extra for all other people or organizations you want me to be able to speak to.
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INTAKE PACKET
This packet will need to be filled out in its entirety. Please read it over and, if you agree, sign each page that requires it.
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In this packet is an extra HIPAA Release form for any person or organization you may want me to have contact with. Examples of these are insurance companies I need to contact, doctors you may want me to correspond with, or a family member who may be helping you pay.
You may leave the HIPAA form in this packet blank if you do not want any more releases of information.
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More HIPAA forms are available upon request.
HIPAA RELEASE FORM
This form should be downloaded and filled out for each person whom you want me to be able to share and receive information from.
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This form was included in the Intake Packet for your emergency contact. Download extra for all other people or organizations you want me to be able to speak to.
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