NEW PATIENTS

FORENSIC EXAMINEES: If your assessment is for a legal purpose, your paperwork is not on this website. If you would like the paperwork for a forensic evaluation prior to your scheduled appointment, please give us a call. 

Complete your forms before your appointment

 

Please complete your forms after scheduling but in advance of your appointment - we cannot see you without them! Our forms are HIPAA-compliant and secure. We recommend you complete them on a computer unless you're really good at typing on your phone or tablet. 

Adult Patients:

Required for all new adult patients:

Required only if you will receive services by telehealth:

Complete if you want to authorize us to email you:

Child/Teen Patients:

Required for new child/teen patients:

Required for child/teen patients in counseling:

Required for new child/teen telehealth patients:

Complete if you want to authorize us to email you:

Other Forms:

Authorization for release of protected health information:

Only complete this if you have been asked by office staff:

New Patient Deposit:

 

A deposit is required to schedule a new patient appointment. Please don't take this personally! This policy is intended to reduce no-shows for first time appointments. The amount of the deposit varies with the service being requested. Most new patient appointments require a $40 deposit, but some lengthy evaluations require $75 or more. The deposit will be applied toward your fee or copayment for your first visit. If your insurance covers our services at 100%, your deposit will be refunded to you after your claim processes. If you wish to cancel your appointment after scheduling, we are happy to refund your deposit if you provide us more than 24 hours' notice. If you need to reschedule, please give us at least 24 hours' notice, or the deposit will be forfeited and a new deposit must be paid. Any subsequent appointments cancelled or rescheduled without at least 24 hours' notice will be billed to you at $40.

New Patients, Please Arrive early!

 

Please arrive at least 20 minutes prior to your scheduled appointment to complete new patient paperwork (unless you have completed it in advance, in which case please arrive 10 minutes early). We typically do not run behind schedule. Your clinician has reserved a specific amount of time for you and will not be able to extend your appointment if paperwork is not ready by the start of your appointment.

 

Don't forget to bring your ID. Bring your insurance card if we will be filing insurance for you. Patients under 18 and dependent adults must bring a legal guardian with them to the first appointment. A stepparent is not a legal guardian unless a court has provided them with paperwork stating as such!

Rates & Insurance

We may be in your network if you have:

We cannot guarantee that services will be covered. Please contact your insurance company. 

 

Click here for important information about using health insurance with us.

 

Click here for our out of pocket rates for clinical services.

FAQ

115 Kildaire Park Dr Ste 313

Cary, NC 27518​

Click for hours of operation

Convenient to Raleigh, Apex, Morrisville, Holly Springs, Fuquay-Varina, and Garner, in Wake County NC

 

Phone:  919.600.4906

Fax:      888.887.6361

Email: info@etheridgepsychology.com

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Material on this website is for information purposes only. Nothing on this website is intended to diagnose or treat any physical or mental illness and does not establish a practitioner-patient relationship. If you choose to email us, you do so at your own risk and agree to allow us to email you in return. 

© 2020 by ETHERIDGE PSYCHOLOGY, P.A.