Please complete the Patient section and email it to me. I will complete the remaining sections and return to you for your signature.
You can then submit this form to your insurance or HSA/FSA.
A SuperBill is an itemized receipt that includes information needed by insurance companies for out of network reimbursements. I am happy to provide a SuperBill to you on a quarterly or semi-annual basis so that you can request reimbursement for your therapy payments. SuperBills can also be used to document payments made from a health or flexible spending account (HSA/FSA). Important: it is your responsibility to determine what benefits are offered by your insurance carrier for out of network providers.