New Patient Information
Are you ready to understand and heal the underlying wounds that are holding you back in your life?
Are you ready to gain clarity and self understanding to make lasting improvements in your relationships, career and life?
Are you ready to understand the root cause(s) of your symptoms and create an individualized treatment plan to alleviate your suffering?
New Patient Orientation
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Clinic can only prescribe one controlled drug if needed and clinically appropriate but with strict monitoring, including random drug test.
We do not accept Patients under 8 years old
We do not get involved with custody proceedings/issues or pre-existing legal cases.
Our providers will review your submitted forms. Once the review is completed, we will contact you – usually within 2-3 business days.
We are currently accepting new patients!
We accept most commercial insurances and offer self pay rates to patients who do not have insurance.
We are completely paperless and all our forms are all online. Please make sure you have a working email and phone number.
In order to have enough time to complete all necessary paperwork, please arrive one hour early for your initial appointment, or complete your new patient intake forms prior to coming in to your appointment. All forms that are required to be filled out are online and you will be sent a link to access them at the time your appointment is scheduled.
Please make sure to fill out all forms (missing sections will just delay your wait time and visit) and make sure to enter the following information in Demographics.
NAME, DATE OF BIRTH, ADDRESS, EMAIL, PHONE NUMBER, Preferred Communication, Driver's License, SSN, Ethnicities, Race, GENDER, EMERGENCY CONTACT (THEY CAN NOT PUT THEIR OWN NAME IN EMERGENCY CONTACT). PHARMACY INFORMATION. FRONT AND BACK OF IDENTIFICATION IS UPLOADED, FRONT AND BACK OF INSURANCE CARD IS UPLOADED. PRIOR AUTHORIZATION IS UPLOADED. If the above information is missing then we will request to fill out the missing information and it may delay your appointment.
CBH self pay rates for mental health are $250 for the initial appointment (this fee includes the initial urine drug screen) and follow up appointments are $150 (with an additional required $50 drug screen approximately every 3 months)
CBH self pay rates for Opioid addiction treatment are $250 for the initial appointment and follow ups are $150 (every two weeks however if they are seeing a therapist at CBH then they can have monthly follow up.
CBH rates for Medical Marijuana certification are $150 for initial evaluations and recertifications are $100 (every 7 months).
Patients with insurance (with the exception of select PPO policies) must obtain a referral from their Primary Care Physician or insurance to be seen. If a patient's insurance reports that they do not need a referral then please obtain a letter from the insurance company stating that they do not need a referral.
Payment is due at the time of service.
We accept zelle, cash, credit, debit, HSA, or FSA as long as they have a Visa or MC logo. We do not accept Amex or checks.
CBH DOES NOT ACCEPT PAYMENTS WITHOUT CREDIT CARD AUTHORIZATION FORM SIGNED AND UPLOADED IN THE CHART. IF PATIENT IS PAYING WITH CASH WE CAN NOT ACCEPT OLD 100 DOLLARS BILLS. NO CHECKS ARE ACCEPTED.
Most banks can send payment by receiver's email. You can go to your bank's online site and log in. There will be an option to pay by ZELLE. almost all banks have it. You can Send the payment through your online banking to account@nepajax.com Name will be Mohammad Farooque
Please be sure to bring the following:
Insurance Card
Picture ID
List of medications currently taking
Custody or Guardianship papers, if applicable.
Please arrive 15 minutes early for subsequent appointments.
Please be aware that we will need half an hour to an hour to process your visit before you may see the provider, as we must undergo several steps to make sure that you are provided the best care.