New Client Information

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To Our New Clients

Complete registration information

In anticipation of your upcoming appointment at the Green House Group, PA, please accept our appreciation for selecting us.  We welcome the opportunity to assist you.

Thank you for taking a few minutes to complete required paperwork and review our office and financial policies prior to your meeting with your therapist.  We apologize for its length and details.  Federal and State law, as well as professional guidelines, require us to inform you of these policies.

Please feel free to ask questions and share your concerns about any aspect of this information.  You may sign the forms upon your review at your initial meeting.*

Verify Insurance Coverage

Prior to your first appointment, please call your insurance company (the telephone number will be listed on your card or within the enrollment documents) to determine the following:

If services are covered with the clinician you will meet
If a referral, notification, or authorization is required
Authorization number (If this is not required by your plan they will let you know that)
Date range of authorization
Number of sessions allowed
Copay amount ($) per session       
Total deductible amount ($) of your plan and current deductible balance (to determine current payment for services) 
Insurance claims mailing address (Note: For mental health coverage, this is frequently different from the address on the back of your card)

If you do not obtain required authorizations, any sessions which occur without authorization will be your financial responsibility.

Registration paperwork

*If you have scheduled your first appointment through Telehealth: 

Send completed and signed forms via:

USPS: 250 Commercial Street, Suite 3004, Manchester, NH 03101
Fax: 1-603-668-8666
Email**: s.peoples@thegreenhousegroup.net  

**NOTE: Although our email system is protected by encryption, there are possible risks associated with sending your personal health information (PHI) through any email system that is not encrypted.

New Client Information

To Our New Clients

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