New Patients

Thank you for choosing us for your therapy needs. We are excited to start the process of helping you find peace and a fulfilled life.

STEP 1: Review the Patient Information Release Form and be ready to discuss it during your intake phone call.

STEP 2: Fill out the below form. Once we receive this information, we will call you and collect some additional details including your insurance information.

* RED = REQUIRED

FINANCIAL POLICY

The below statements constitute our financial policy. Please check all indicating that you have read and agree to be bound by them while a patient of Dr. Robert S. Maris Ph.D., P.A. All are required.

NOTE: Most insurance companies have waived co-pays and deductibles for Telemedicine during the COVID-19 pandemic. Check with your carrier to confirm.

Payments of deductible, co-pays and any non-covered services is due at the time of the service.

Non-Insured patients are expected to pay in full at the time of the service

Patients will submit payment in one of the following forms of payment: cash, checks, Visa, Mastercard or American Express

Late cancellations (less than 24 hours) and no-shows are charged a $50 fee

If your insurance insists on pre-authorization or referrals, it is up to the patient to obtain those permissions. Lack of referral when needed will result in the patient being responsible for the entire amount.

New Patients

FINANCIAL POLICY

BY SUBMITTING THIS FORM, YOU AGREE THAT ALL OF THE ABOVE INFORMATION IS TRUE AND ACCURAGE TO THE BEST OF YOUR KNOWLEDGE.

Disclaimers