Client Onboarding Notice
Client's Name
*
First Name
Last Name
Which of the following applies?
*
New client
Returning client
Client is being transferred to me from another provider
Client participates in couples therapy with another Medens provider and wants individual therapy
Client receives individual therapy and wants couples therapy
Client was recently tested and I am the newly assigned therapist
Care Requested
*
Adolescent Therapy
Adult Therapy
Couples Therapy
Pre-surgical Evaluation
ADHD Targeted Evaluation
Autism Targeted Evaluation
Diagnostic Clarification Evaluation
Other
Financial Arrangement
*
Insurance
Self-pay
ProBono
Insurer (if known)
*
Please Select
Aetna
Aetna Better Health of California
Anthem BlueCross of California
Anthem BlueCross/Blue Shield of Nevada
BlueCross/BlueShield Federal Employee Program
BlueShield of California
BlueShield Promise Health Plan
California Health & Wellness
CalOptima
Cigna
ComPsych
Gold Coast Health Plan
Health Plan of Nevada
HealthNet
Humana
Inland Empire Health Plan
LA Care
Magellan
Medicare
Molina Healthcare
Oscar Healthcare
Oxford
San Francisco Health Plan
SCAN Health
Sierra Health & Life
Silver Summit Health Plan
N. Las Vegas Fire Fighters Union
Tricare
TriWest / VA Community Care Network
UnitedHealthCare
UMR
Not sure
N/A - Self-pay
N/A - ProBono
When is the first appointment? (If known)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Comments
Today’s Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Your name
*
Please Select
A’Jah Love, LMFT
Alexandra Schenitzki
Amberlyn Dinh, MA
Andrew Walsh, AMFT
Arlet Talamantes, AMFT
Bianca Islas
Cameron Walsh
Christy Merrill, MA
Dr. Alicia Vander Dussen, PsyD
Dr. Brendan Nierenberg, PsyD
Dr. Dianne Kong, PsyD
Dr. James Maltzahn, PsyD
Dr. Jesse Scott, PhD
Dr. Kaelyn Griffin, PhD
Dr. Kristine Goodman, PsyD
Dr. Kristopher Kern, PsyD
Dr. Leandrea Caver, PhD
Dr. Mariam Harris, PhD
Dr. Meghan Walls, PsyD
Dr. Melody Kia, PhD
Dr. Michelle Poston, PhD
Dr. Mindia Gabichvadze, PsyD
Dr. Nicole Anders, PsyD
Dr. Rocky Blackwell, PsyD
Dr. Stephen Pines, PsyD
Dr. Tara Rostami, PsyD
Eden Raitman, AMFT
Eli Ballard, MA
Ella Schumaker, AMFT
Esther Olajide, LMFT
Goldie Geisinsky
Helma Jafari, LMFT
Ilana Behar, LMFT
Irene Akther
Jackie Shlain, LMFT
Javeed Kassam, AMFT
Jonathan Ubiera
Katia Alyabyeva, AMFT
Kirsten Jackson, AMFT
Makenna Maimin, AMFT
Meesha Merat, AMFT
Michael Brown, AMFT
Montse Hernandez, AMFT
Nahreen Aref, LMFT
Olivia Glover
Olivia Ringeis, MA
Sabrina Shalemi, AMFT
Shelby Silver, AMFT
Victoria Vizcarra, LMFT
Zoë Steinbarth, AMFT
Other/Not Listed
Submit
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