Downloads

Please download and print the New Patient Intake Form, and the Physician-Patient Agreement. Please fill out the forms in their entirety and bring the completed documents to your initial evaluation. You may need to download and install Adobe’s free Acrobat Reader to open these documents.

Also, please review the HIPAA Notice Of Privacy Practices document. This notice should be reviewed carefully. It describes how medical information about you may be used and disclosed and how you can get access to this information.

If you are already in treatment with another mental health provider, you will also need to download and print the Consent For Release Of Information and bring this to your initial evaluation. Be sure to fill out the name of your therapist and his/her contact information at the top of the Consent form.

Matthew R. Mills, MD, is not affiliated with any health insurance networks. If you would like to use your private health insurance, you would be seeing Dr. Mills on an “out of network” basis.

Nearly all major insurance carriers provide benefits for out of network services. You are encouraged to call the member services telephone number on the back of your insurance card to ask about your level of reimbursement for out of network visits.

If you choose to see Dr.Mills on an out of network basis, he will provide you with a detailed billing receipt containing all of the information you would need to submit the claim to your insurance for direct reimbursement. The overall process is much easier than one might think. Please review the section entitled ‘Insurance Reimbursement’ on page four (4) of the Physician-Patient Agreement for more information.

Self-pay patients (i.e., patients not using any form of health insurance), are most welcome! My professional fees for self-pay patients are clearly outlined in the Physician-Patient Agreement.