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A New Dawn Psychotherapy Associates
308 E Broad St
Bethlehem, PA 18018
p/ 610-861-8779
f/ 610-861-4677
Client Forms for Your First Appointment
Adult Intake Packet
If you are using insurance, please complete the highlighted sections on the HCFA form.
For couples, please list the name first for the person for whom you wish us to bill insurance under, and complete the HCFA with their name only.
Child Intake Packet
If children are to be involved in services, we require consent from each person (parent or guardian) who has legal custody of the children. If there is joint legal custody, both parties must give consent prior to the first session, unless services are ordered by the court.
Court Ordered Services Packet
All parties who have been court ordered to counseling must complete this packet and provide a copy of the court order
Our Health Insurance Privacy and Portability Act (HIPPA) Policy
We require a completed release to exchange information
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