New Patient Forms
All our forms open with Adobe Acrobat reader, you can download it for free here.
Click the links below to download the corresponding form.
Genesis Clinical Services accepts the following Insurance Plans: Blue Cross PPO, Medicare, Aetna PPO. All other carriers are considered out of Network. We do offer competitive self pay rates for 1st initial evaluations and follow up appointments with all our Providers. A copy of the Encounter Form will be given to each patient at time of visit. Patients can submit to out of network carrier for reimbursement.
Initial Evaluation Follow-up Appointments
MD, DNP, APN $295 $150 30 minute session (Medication Management)
PhD, PsyD $250 $165 45-60 minute session
LCPC, LCSW, LPC $225 $145 45-60 minute session