Mind Over Matters Client Forms

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete the form to authorize a release of psychotherapy information:

If you want to use your insurance benefits and/or are unsure of your mental health benefits, we accept numerous types of insurance as well as out-of-network coverage. Please contact us at 714-654-1570 or fill out this form online to have your benefits verified. Please feel free to text message with your name, date of birth, address, insurance plan, policy #, ID number, authorization number and EAP info if applicable. Please let us know your time preferences as well.


***FORMS REQUIRE ADOBE ACROBAT IN ORDER TO VIEW OR FILL OUT ON YOUR LOCAL COMPUTER AS WELL AS TO PRINT.***

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If you’re a new client at Mind Over Matters:

Please complete the following mandatory forms and bring them to your first therapy session, or submit them below.

Please read and sign the following release of information and telemedicine forms: Please fill out and sign the last page of these forms.



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inquiry@insightfulmatters.com
714-654-1570

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