Forms

YOUR FIRST APPOINTMENT

Call me at (417) 882-4110. I handle all my tasks, including scheduling and billing. Therefore, you will not deal with staff, but instead will deal directly with me. If I do not answer your call directly, leave a message, and I will return your call.

Once we set an appointment time, complete the Initial Information Form. Print it, and bring it with you to the appointment.

If you intend to use insurance, complete the Insurance Form. Print this form, sign and date box 12, sign box 13, and bring it with you to the appointment. Call your insurance company. Indicate that you want to see David Lutz for counseling. Ask about your deductible, co-payment, and any other financial issues related to your insurance.

Read my Privacy Notice.

Read my Psychotherapy-Client Services Agreement. Complete the last page with your credit card number. Print that page, sign and date it, and bring it with you to the appointment.

Bring these completed forms with you to the appointment. Try to arrive about ten minutes early as our building is sometimes a little difficult to find. My office is at 1320 E. Kingsley, Suite A, directly behind (to the south) of the AIG building. Look for the CPC building sign on Kingsley street to guide you down our “driveway.”