Request for Services

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Please provide information for the individual seeking services (the potential client). If the potential client is a minor, a parent or legal guardian should complete the form and provide their contact information where indicated. We will use the collected information to verify insurance coverage and determine service eligibility.

 

Complete this section only if someone other than the potential client is completing this form.

THIS FORM IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.

NEXT STEPS

Now it’s just – 3 Easy Steps to Receiving our Services:

 

  1. We will reach out to you if any additional information is needed to verify your coverage benefits or clarify services requested.
  2. Typically within 48 hours, our intake coordinator will call to inform you of your coverage and schedule you for an initial appointment.  If you do not hear back, please do not hesitate to give us a call.
  3. Once you have a scheduled appointment, you will be sent an email with a link to enter your client portal.  This is where you will complete our practice documents prior to your first appointment.

* Blue Skies is a paperless practice. After scheduling your first appointment, our intake coordinator will email you the link to complete our practice documents and credit card form. If you do not receive this email within 24 hours, please check your spam. If it is still not there we may have mistyped your email, so please call 347-464-5550 ext.1 and let us know.

Please fill out the intake forms at least 48 hours before your first appointment. Please note, the form takes about 10-15 minutes to complete, as it includes questions that help your therapist get to know you. Sessions cannot be held without intake forms and a valid credit card on file.

Please, note you can cancel and reschedule appointments, view documents that have been sent to you, and view your billing invoices all through your client portal.