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First session therapy Paperwork

Click on a file to download.

Leora Black September 2023 First Session Paperw (docx)Download

TElehealth Client information and informed consent

Leora Black Telehealth Consent & Safety Plan (docx)Download

Good faith estimate

Rates and Good Faith Estimate (3) (6) (docx)Download

Leora Black,Ph.D., LMFT, LCMHC

Credentials

Therapy and Training

Therapy and Training

Licensed Marriage and Family Therapist, Licensed Clinical Mental Health  Counselor, Approved Clinical Supervisor, American Association Marriage and Family Therapy

Therapy and Training

Therapy and Training

Therapy and Training

Individuals, families, young children, teens, adults and supervision with graduate and post graduate interns.

Experience

Therapy and Training

Insurance and Employee Assistance Programs Accepted

36 years of experience, specializing in brief treatment, anxiety, depression, separation, divorce, trauma, school related issues, women's issues, grief, loss, transitions, autism, ADHD.

Insurance and Employee Assistance Programs Accepted

Insurance and Employee Assistance Programs Accepted

Insurance and Employee Assistance Programs Accepted

BC/BS, Cigna, MVP, CBA,  Aetna, Multi Plan, Value Options, Medicaid,  Beacon, New Directions EAP, Mutual of Omaha EAP, JP Smith EAP

First Session Paperwork

Insurance and Employee Assistance Programs Accepted

Contact information and Hours

Please click on the files above, complete and bring to first session with your insurance card, copay or deductible.  Cash preferred, check accepted, no cards processed

ALL PAGES NEED TO BE RETURNED INCLUDING NON SIGNED PAGES!

Thank you.


Contact information and Hours

Insurance and Employee Assistance Programs Accepted

Contact information and Hours

802-264-5333 ext. 101 

Colchester

Monday through Wednesday 8am-5:00pm

 Thursday limited availability

Colchester 

          

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