If you are a New Client, please visit https://getamb.com/portal to electronically fill out your insurance information.
In addition, there are forms that must be printed off, filled out, and sent back to me. (At this time they cannot be done so electronically.) Please click on the appropriate links below, print out and complete the forms, and send them back to me. You may do so several ways:
1) Emailing the forms back to my HIPAA secure email at [email protected]
2) Uploading them through the HIPAA secure client portal message center once you have created a client portal account
For All New ADULT Clients (ages 18 years and older) :
For New ADOLESCENT Clients (under 18 years of age):
NEW CLIENT PACKET (to be filled out by Parent)
ADOLESCENT CLIENT QUESTIONNAIRE (to be filled out by Parent)
ADOLESCENT SELF REPORT FORM (to be filled out by Adolescent)
OPTIONAL Release of Information Form for All Clients:
AUTHORIZATION TO RELEASE INFORMATION
Note: To download Adobe Acrobat Reader for free, click here .