New Client Forms

If you are a new client and interested in scheduling an appointment please complete the following:

1. Contact your insurance company for benefit information regarding therapy allowance, copay and deductible status.
2. Call Beverly at 682- 252-9816 or e-mail at beverlystubblefieldlpc@gmail.com for scheduling. Current client appointments can be scheduled through phone call, text message or e-mail.
3. Print and complete the following forms and bring to your scheduled appointment.

Required Documents:

• Client Information Form

• Informed Consent Office Policy
• Release of Information
• Copy of Client Driver’s License (Clients under 18 use Parent DL)
• Front and back copy of current Insurance Card
• Front and back copy of credit-card or payment card. Card numbers will be secured in a computer-file and destroyed immediately after being put into the computer system.

If you are unable to print and complete the required documents, please arrive to your appointment 15 minutes early to avoid lost session time.

Thank you!

Beverly