The following forms must be reviewed, filled out (as necessary) and signed or initialed where indicated prior to your first session with me. Doing this work in advance will save valuable time in the office. Please click on each link below to print the forms:
IMPORTANT: Our office is a fee-for-service office (private pay). Clients receive a receipt at each session which they may file to their insurance company for “out of network” benefits. Dr Crow does not take Medicare. Diagnosis can affect reimbursement and will be discussed in the initial session. If you have any questions about this, please contact Dr Crow at: 480-947-1989.
Authorization for Information Release