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 12) 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