Center for Balanced Living

Center for Balanced Living Send Message

Who would be receiving care?

Me

Someone else

Your info

First name

Last name

Email

Phone

Name you go by

Date of birth

Gender

Reason for care

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

Client Preferences

Preferred appointment times

Morning Afternoon Evening

Preferred clinician

Select a clinician from the list

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Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

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Billing & Payment

What insurance will you be using?

We accept BlueCross BlueShield, Aetna, HighMark Health Options and Medicare. We also provide a reduced self-pay rate and provide super bills if we are out of network with your insurance.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.