Patients

New Patients

Please download and complete the following forms and bring them to your first session. The demographic form asks for identifying information including your name, address, phone numbers, etc.

David also invites you to read the Notice of Privacy Practices that describes the uses and disclosures of health information about your confidential medical record. After you have read this information, please download the HIPPA signature form, sign and date it, and bring it to the first session. This signifies that the HIPPA information was made available to you.

David is happy to answer any questions you have about this information or any other aspect of mental health treatment at your first visit.

 

Forms

You will need Adobe Reader to download these forms.

*Demographic Form
*HIPAA Notice Acknowledgement
*Patient's Rights and Responsibilities
Consent for Release of Information

*bring completed forms to first session

 

Insurance

If you plan to use your medical insurance, please bring your health insurance card with you so that David can make a copy of it.

David recommends that you call the member services phone number on the front of your insurance card and confirm that seeing David is a covered service under your plan. At that time you can also ask whether you need a referral from your doctor, and confirm what your co-pay will be.

If you do need a referral, simply call your primary care doctor’s office and ask them to call in the referral to your insurance company. You will need to tell your doctor’s office that you want to see David Schwab, LCSW-R. Locally, Preferred Care generally requires a physician referral, Blue Cross & Blue Shield, generally do not require a physician referral.

Payment for all services is due on the day of the service. David accepts personal checks or cash.

 

95 Allens Creek Rd  •  Executive Square  •  Building 2, Suite 16  •  Rochester, NY  •  14618