New Client PAPERWORK AND Client FORMS

Register on our Patient Portal and click on the "Intake Paperwork" link to submit new client paperwork.

See below for printable Client Forms.

New Intake Paperwork.Demographics (pdf)

Consent to Treatment for Minors.8.1.2024 (pdf)

Release of Information of PHI (pdf)

Payment Agreement CC on File (pdf)

Good Faith Estimate.8.1.24 (pdf)

Sliding Fee Application (pdf)

GAIN Agreement (pdf)

Informed Consent and Client Rights - Adult.08.05.24 (pdf)

Informed Consent and Client Rights Child.Adolescent 8.1.24 (pdf)

Payment Methods

Easy Ways To Make Payments

We Accept Most Insurance Plans

We Accept Most Insurance Plans

Important Note: Even though we take insurance and will do all in our power to receive payment from your insurance provider, you are still responsible to verify they will cover your services. We do our best to ensure proper billing, but you will be responsible for any payments not made by the insurance company (deductible, copay, or missed sessions).

We accept cash, checks or credit card to pay for appointments or fees at Crosspointe Family Services. Returned checks will be charged a $30 fee.

Your appointment is essentially reserving the therapists time and office. If you are more than 10 minutes late to your appointment, you will be responsible for missed session fee ($75), due at the next scheduled session. If you fail to cancel your appointment at least 24 hours in advance, you will be responsible for the missed session fee ($75), due at the next scheduled session.

We also accept payment from other third party payers, outside of insurance companies, however this needs to be arranged between you and the payer before services are started. If the payer ends payment, you will become responsible for payments not received.

Submit Credit Card Payment

We Accept Most Insurance Plans

We Accept Most Insurance Plans

We Accept Most Insurance Plans

Aetna
Beacon Health
Blue Cross of Idaho
Blue Cross Medicare Advantage
Blue Cross True Blue
Bright Path
Business Psychology Associates (BPA)
Evernorth (previously Cigna)
Coventry
First Choice Health
First Health Network
Idaho Physician’s Network
Medicare
Medicaid (Idaho Optum)
Mountain Health Co Op
MultiPlan
Pacific Source Commercial Plans
Pacific Source Medicare Plan
Regence Blue Shield
Select Health
St. Luke's Health Plan
Tricare
University of Utah Health Plans
United Healthcare
Uprise Health EAP
For your convenience, we also have a self-pay rate and a sliding fee schedule.

See Self Pay Rates Here