InnerQuest NC Psychiatry and Counseling

Yearly Update Forms

With all the new insurance changes and updates in the upcoming year, we are urging you to contact your insurance company to verify your coverage for services. We have attached a form for you to have completed before your next appointment. This will better help you in determining the amount of your deductible, your required copayment, any limits concerning the number of mental health visits your insurance allows. Please bring in the completed Benefits Confirmation Form so that our staff may verify your benefits to your upcoming visit. Payment is expected at the time of service. If our staff is unable to verify your benefits or confirm the amount of your co-payment and deductibles you will be required to pay the full amount of the visit.

We have also attached our Financial and Cancellation / No show policy form. We will need you to review and sign and return to the office at your upcoming visit. 

Please click on link below to download these forms.  We look forward to seeing you at your next visit.