Provider Forms
The following forms are provided as a convenience to our clients. We cannot guarantee that any form is the most current version, nor that it will be accepted by an insurance company.
Most forms are PDF files; the remainder are Microsoft Word documents. The free Adobe Acrobat Reader is required to view, fill in, and print PDF forms. If you don’t have Adobe Reader installed on your computer, click the button below to go to the Adobe Reader download site:
When you click on one of the underlined links below, the form will be displayed in your Web browser. To print the form, click the printer icon on the Adobe Reader toolbar just above the top of the form (not your Internet browser’s toolbar).
- Psychotherapy Day Sheet (Fillable) with Telehealth
- Anthem Blue Cross of California
Anthem Blue Cross and Blue Shield of Indiana
Anthem Blue Cross and Blue Shield of Kentucky
Anthem Blue Cross and Blue Shield of Ohio
Anthem Blue Cross and Blue Shield of Virginia- Beacon Health Options (formerly ValueOptions)
- Blue Cross of Idaho
BlueCross BlueShield of New Mexico- CareFirst BlueCross BlueShield of the National Capital Area
Empire BlueCross BlueShield
Federal Employee Program (FEP) in the Mid-Atlantic States
Highmark Blue Cross and Blue Shield
Interface EAP Clinical Feedback Form
Magellan Behavioral Health- Maryland Uniform Treatment Plan
Minnesota Universal Outpatient Mental Health Authorization Form
Mutual of Omaha
New Directions Behavioral Health
United Behavioral Health