Renaissance Therapy Clinic Empowerment for Postive Change
	INSURANCE & FORMS "A Holistic Approach to Treatment" Aetna Behavioral Health Behavioral Health Systems Blue Cross Blue Shield Cigna Behavioral Health Comprehensive Behavioral Health ComPsych CLINIC FORMS If you have scheduled an appointment, please download and complete the following forms. The completion of these forms before you come to our office allows you to gather your important information before your first visit, which in return allows us to spend our limited time together in the most effective and efficient manner. If you have scheduled an appointment for neurotherapy, please download and complete the neurotherapy forms (bottom of page) in addition to the standard Intake Forms. Please bring all of the completed applicable forms with you to your first appointment. Thank you! Corphealth Integrated Behavioral Health Integrated Health Plan Magellan Managed Health Network Molina Intake Forms Patient Information Consent to Treatment Release of Medical Information Symptom Checklist Patient History Child & Adolescent History MultiPlan Private Health Care Systems PPOM Cofinity Tricare United Healthcare Value Options Neurotherapy Forms Neurotherapy Informed Consent CNS Functioning Assessment Reactivity Vitality Questionnaire Session Treatment Assessment ATEC (Autism) INSURANCE & PAYMENT INFORMATION We will discuss fees, insurance coverage, and billing prior to your first appointment. Dr. Vandalov is a network provider with numerous insurance plans (above-left links). If you do not have health insurance or choose not to use your insurance coverage, we are willing to work with you for affordable private payment arrangements.