Renaissance Therapy Clinic Empowerment for Postive Change
	INSURANCE & FORMS "A Holistic Approach to Treatment" Intake Forms Patient Information Informed Consent Patient History Neurofeedback Consent CLINIC FORMS If you have scheduled an appointment, please read carefully Renaissance Therapy Clinic's Policies and Privacy Practices. If you are in agreement with these policies, please download and complete the Intake Forms (left panel) prior to your appointment. 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 neurofeedback, please download and complete the Neurofeedback Consent in addition to the standard Intake Forms. INSURANCE & PAYMENT INFORMATION We will discuss fees, insurance coverage, and billing prior to your first appointment. Renaissance Therapy Clinic is a network provider with numerous insurance plans. If you do not have health insurance or choose not to use your insurance coverage, we are willing to work with you for affordable self payment arrangements. rEEG Forms Physician Referral Physician Requisition Physician Guide Half-Life Table Medication Chart REEG FORMS Although no prescription is legally necessary to administer the rEEG, we suggest that you obtain an advance referral from your physician. Not only does this keep your physician in the loop, but it affirms to your insurer that this is medically necessary for you. Prior to scheduling an rEEG, please carefully read the Patient Information Letter. Download the Physician’s Guide that briefly explains rEEG and the rEEG Referral and Requisition Forms. Respectfully request that your physician work with you. He or she will need to complete and sign the rEEG Referral and Requisition Forms. If your physician has any questions or concerns, please ask that he or she contact our office.