Intake Paperwork
No Insurance?
If you do not carry insurance we do accept private pay. We don't publish the rates, please discuss with your clinician during your visit or call our office for more information.
All Intake Paperwork
Release of Information / Payment Method
D0 NOT FILL OUT - Release of Information unless you've been specifically requested to do so by your clinician. Only the intake paperwork is necessary unless you've been specifically asked to do one of the others.
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Release of Information
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Payment Method - Separate
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24 Hour Cancelation Policy
We realize that emergencies and other scheduling conflicts arise and are sometimes unavoidable. However, advance notice allows us to fulfill other patient's scheduling needs and keeps the office operating at its most efficient level.
Please provide our office with 24-hour notice to change or cancel an appointment. Patients who do not attend a scheduled appointment or do not provide 24-hour notice to change a scheduled appointment will be responsible for a $100.00 service charge. This charge cannot be billed to insurance and therefore must be paid by the patient by your next billing cycle.
All notice of canceled appointments should be made to 406-272-2511 only, do not send messages to clinicians' private lines. Cancelations need to be made on weekdays as we work to fill open time slots during the week, not on weekends. For example, weekend or Holiday texts or calls to cancel an appointment for the next weekday appointment would violate the policy.
If you are not feeling well, we can easily convert an appointment from face-to-face to a telehealth appointment. Please just send the request to the number listed above.
After two missed or canceled appointments, without the appropriate 24-hour notice, you may be placed on a same-day scheduling policy for your treatments, which would not allow you to schedule any appointments in advance.
Please provide our office with 24-hour notice to change or cancel an appointment. Patients who do not attend a scheduled appointment or do not provide 24-hour notice to change a scheduled appointment will be responsible for a $100.00 service charge. This charge cannot be billed to insurance and therefore must be paid by the patient by your next billing cycle.
All notice of canceled appointments should be made to 406-272-2511 only, do not send messages to clinicians' private lines. Cancelations need to be made on weekdays as we work to fill open time slots during the week, not on weekends. For example, weekend or Holiday texts or calls to cancel an appointment for the next weekday appointment would violate the policy.
If you are not feeling well, we can easily convert an appointment from face-to-face to a telehealth appointment. Please just send the request to the number listed above.
After two missed or canceled appointments, without the appropriate 24-hour notice, you may be placed on a same-day scheduling policy for your treatments, which would not allow you to schedule any appointments in advance.