All first appointments will require several intake forms. Please read and sign the forms below and email them to me prior to our first session.
- Print the blank forms
- Complete, sign, and date all forms
- Scan or photograph the forms
- Scan or photograph the front & back of your insurance card
- Email all items to me at lisa.livshin@icloud.com
Intake Form
Private Practice Information and Financial Agreement
Privacy Policy (Please Read)
HIPAA
Consent Form for Teletherapy
All fees available upon request
Tele-Therapy: Dr. Livshin offers web-based therapy through a secure, HIPAA compliant platform to patients who are unable to meet in person.
Payment is due in full at the time of the appointment. Dr. Livshin is a contracted provider with Blue Cross Blue Shield and Medicare. Her office will bill these policies directly. You are responsible for the co-payment or deductible at the time of your session.
If Dr. Livshin does not accept your insurance, and you have out of network benefits, please make payment at the time of your visit. Dr. Livshin will provide you with a receipt with the necessary information for you to obtain reimbursement.
Checks, credit cards, HSA cards, Zelle, and PayPal are accepted.