Client Forms, Insurance and Payment Information

Insurance

We accept most Blue Cross Blue Shield plans (except EPS network). Please verify with BCBS to ensure Bevill and Associates / Al Bevill is in your network.

Payment

Cash, Check and Credit Cards (Visa, Master Card, American Express and Discover) are accepted forms of payment.

Cancellation Policy

If you do not show up for your scheduled therapy appointment, and you have not notified us at least  24 hours in advance for scheduled appointments on Monday – Friday and 48 hours in advance for scheduled appointments on Saturday or Sunday, you will be required to pay the full cost of the session.

 Forms

Bevill and Associates LLC has many forms available below for new and existing clients

All documents are available in PDF format. If you do not have Adobe Acrobat installed, please click here to obtain a free adobe Reader.

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2017 Client Information Update Form

2017 Client Information Update  (click here)

 

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New Client Form For Individuals, Couples, & Families

All new clients are required to complete the New Client Information Form, as well as the Disclosure Statement Form. To access these forms, please click on the links below:

Patient Intake Information  (click here)

Adolescent – Teen New Client Form  (click here)

 

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RELEASE OF INFORMATION FORM

For clients to request records

This form is utilized for clients to provide or receive authorization to release personal and confidential information.  To access this form, please click on the link below.

Release of Information 2017  (click here)

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Informed Consent For Group Therapy

For all new group members

All new group members are required to complete a New Group Member Participation Form

Informed Consent For Group Therapy (click here)