NEW CLIENT FORMS

​Welcome to ETCH!  

We look forward to meeting you at your initial appointment. In the meantime, please feel free to review the following material and bring the completed forms to your upcoming appointment:

Notice of Privacy Practices

Information Sheet

Consent to Treat

General Health Questionnaire

Authorization to Use Unencrypted Email or Texting

Consent for Telehealth Services

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INSURANCE

We currently accept the following insurances:

Aetna
Blue Care Network
Blue Cross/Blue Shield
Cofinity
HelpNet EAP
Magellan
McLaren
Meridian
Military One Source (ValueOptions)

Molina
New Directions EAP
Optum
Physician Health Plan
Priority Health
Tricare
United Behavioral Health
ValueOptions

​A sliding fee scale may be available.

To pay online, please click here