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We Help with
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Teletherapy at BETA
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Appointment Type
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Teletherapy
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Please check the box indicating your preferred method of payment, check all boxes that apply
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Blue Cross
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Other
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Other Payment Method
Is your insurance a "PPO"?
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Yes
No
(This means that we can see you regardless of whether our practice accepts your insurance or not.)
Please see your insurance card for the following question, Do you have a deductible
Yes
No
If yes, how much is it?
$500
$1,000
$1,500
Has your deductible been met this year already?
Yes
No
Not Sure
I am available to make an appointment on: (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Can you make early morning weekday sessions? If yes, beginning at
7am
8am
9am
Can you make weekend appointments? If yes
Only Saturday
Only Sunday
Either day could work
Therapist Preference
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Female Therapist
Male Therapist
First Available
No Preference
Preferred Appointment Time
Morning
Afternoon
Evening
Can you make weekday appointments that begin from 10am-3pm?
*
Yes
No
Our private pay rate is $165. On a limited basis we can consider a reduction in rate of between 10-25% depending on circumstances. If insurance coverage is not available or desirable to you, can you pursue private pay care?
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No
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How did you hear about us?
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