Getting Started

Let’s get started!
Welcome to Medens Health!

All of the information you disclose is protected by HIPAA and will remain confidentail. You can use a smartphone, tablet, or computer to fill this out.

We make every effort to respond as soon as possible. However, if you contact us after-hours, over the weekend, or on a holiday, our follow-up may be delayed.

If you need urgent support, click here to head over to our website for a list of services that are available 24/7.
Appointment availability as of May 1, 2023

Arizona:
All providers offering services are full and not accepting new patients at this time. The next available appointment is in July.

California:
Counseling/therapy: We are accepting new patient appointments within 10 business days. Most availability is for online/telehealth; in person is only available in Beverly Hills.
Psychological testing: We are accepting new patients with first appointment dates in early June.

Iowa:
We are accepting new patient appointments within 10 business days. Appointments are offered online.

Michigan:
All providers offering services are full and not accepting new patients at this time. The next available appointment is in August.

Nevada:
All providers offering services are full and not accepting new patients at this time. The next available appointment is in August.

Washington:
All providers offering services are full and not accepting new patients at this time. The next available appointment is in July.

If you would like to be added to the waitlist, please note your preference in the comments section.
I have read and acknowledge the above.*

Are you seeking therapy / counseling?*

YesNo
Since you answered Yes, what type of therapy are you seeking?*

CouplesFamilyGroupIndividual Teen (13+)Individual Adult

How do you plan to pay for our services?
Do you intend to use your health insurance or do you prefer to pay out of pocket?

If you want to use insurance, keep in mind:

- Insurance will only pay for services in cases where symptoms meet criteria for a qualifying mental health diagnosis, whether or not they cause significant suffering.

- Insurance companies often place restrictions on the type or amount of therapy that can be provided.

- Your health records are not private when going through insurance. If you choose to use your health insurance, you agree to allow claims adjustors to audit your complete record any time they want.

- In the event that congress or the courts repeal protections for patients with pre-existing conditions, your mental health diagnosis could be used as a pre-existing condition to deny payment for future services.
What’s your payment preference?*

Self-pay - I'll pay out of pocket for all servicesI want to use insurance as my primary payment method

We need your plan information to check eligibility. You'll also need to upload pictures of your insurance card and photo ID. When you have these cards in hand, click Next to continue.

By disclosing your insurance information, you authorize Medens Health to verify your mental health eligibility and benefits, including any copay and/or deductible. Results are typically available in one to two business days.

Each provider has different circumstances when it comes to insurance. Some don’t accept insurance, some accept a few plans, and some accept many.

If you have specific questions regarding your mental health benefits, please contact your healh plan directly.
Insurer:*
Mednes Health is contracted with these insurers only. If yours isn't listed, select 'Other' and provide further details in the Comments section on the next page. If your preferred provider is not contracted with your plan, we will inform you and present others who are In Network.
ID Number:*
Insurance card issue date:

MonthDayYear
If known
Date of Birth:*

MonthDayYear
Date
Upload a copy of your insurance ID Card.*

Cancelof
Upload a copy of your state issued DL / ID card.*

Cancelof
Address on file with your insurance plan:*

Street Address

Street Address Line 2

CityState

Zip Code
Do you receive your health insurance through Medicaid / Medi-Cal?*

YesNo
Since you're a Medicaid / Medi-Cal beneficiary, we need the number on your BIC (Benefits Identification Card), too. If you don't have the card handy, please enter your Social Security Number (SSN) so that we can accurately process your claim. *

Is there anything else you'd like to add regarding insurance, availability, preferences, or other general comments or questions? To ensure your privacy, please limit your response to the areas listed. We will gather more information about your circumstances during the intake process.
How did you find us?*
Date*

MonthDayYear

MinutesAM/PM Option
Please sign.*

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