Client Intake Forms - Dr. RBF
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Click on the applicable forms below to fill out online.

Forms for New Clients

Questions? You can reach directly via email at info@drrbf.com.

Therapy Client Forms:

THERAPY INTAKE FORM

THERAPY AGREEMENT

Coaching Client Forms:

COACHING INTAKE FORM

COACHING AGREEMENT

Release of Information:

Fees and Insurance Information

Therapy:

I value confidentiality and believe that your therapy should be guided by you, rather than your insurance company. Therefore, I do not participate in managed care plans.

I collect payment at the time of service via Venmo or Zelle. At the end of the month, I’ll give you a receipt which includes all of the information you need to submit for reimbursement.

Please check with your insurance company prior to our first meeting to understand your benefits. You can ask your insurance company the following questions:

 

  • What is the coverage for “outpatient psychotherapy services?”
  • What is the percentage of reimbursement for an “out of network provider” including any deductible amounts?

 

Coaching:

Coaching is never covered by insurance. Depending on what our engagement is I may be paid privately or through your company.

I accept Venmo and Zelle as forms of payment.

Contact me with any questions and to schedule your initial consultation.

Ready to see where your potential can take you?