Sari Hands PLC
Facilitating Health and Wholeness
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
