Client Forms

If you would like your therapist 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.***

DOWNLOAD ADOBE FOR COMPUTER

DOWNLOAD ADOBE FOR ANDROID

DOWNLOAD ADOBE FOR IPHONE


Privacy Notice and Informed Consent

Financial Agreement


Please read and sign the following release of information and telemedicine forms:

Fill out and sign the last page of these forms.


Spanish


 



inquiry@insightfulmatters.com
714-654-1570

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.