Forms *When you arrive at my office, please have a seat in the waiting room and I will come to get you for your appointment.



To determine if your insurance will cover therapy at Sari Hands PLC:

Insurance Verification

For Insurance paperwork (ages 12 and older) please print and complete the following:

**Please read Privacy Policies (Updated 9/23/13) and print a copy for your records if you wish

Privacy Practices

Insurance Face Sheet

Financial Policies

For Wellness/Cash Pay paperwork, please print and complete the following:

**Please read Privacy Policies (Updated 9/23/13) and print a copy for your records if you wish

Privacy Practices

Wellness Face Sheet

Financial Policies

For pediatric clients (up to age 10) please print and complete the following:

**Please read Privacy Policies (Updated 9/23/13) and print a copy for your records if you wish

Privacy Practices

Pediatric Face Sheet

Financial Policies

To pay by credit card, please print and complete the following:

Credit Card Authorization


Seal-Compliassure_Confirm