Forms

If someone attends therapy with you (i.e., your spouse, partner, friend, colleague, etc.) they (the non-client) review and sign this form.

The Consent For Services Form contains disclosures, policies and procedures of Full Heart Therapy, LLC by Andrea Nus, LMFT member. Agreement, including your signature, to these policies and procedures is necessary to begin therapy. Together, we verbally review this form and address any questions in your initial session.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) is United States legislation providing data privacy and security provisions for safeguarding your medical information.

Use the Insurance Questionnaire/Confirmation of Benefits form to ask your Insurance Provider questions regarding reimbursement of services with an Out-of-Network Provider. Hopefully, this form assists you in better understanding your insurance policy and benefits, as well as help you make a more informed decision in choosing to work with me.

As of January 1, 2022, state-licensed or certified health care providers must give a Good Faith Estimate of healthcare charges to every new and continuing client who is either uninsured or is not planning to submit a claim to their insurance for the healthcare services they seek. Once you schedule an initial appointment you will recieve a letter to review and an additional form to fill out, through the Client Portal.

In the event you want me to communicate with another person (physician, psychiatrist, current or former therapist, etc.) regarding your care, use this form to give me permission to do so.

Telehealth (online) sessions are conducted through the Client Portal. This form explains the risks of telehealth sessions. If you have questions or concerns regarding telethealth, please contact me before the initial session.