logoM.A., LMFT (MFC 50298), M.S., LAc. (AC 8941)

Insurance Preauthorization Form

Insurance Preauthorization Form:

Find below the Insurance Pre-Authorization Form. It is for your personal use only. It is designed to help you clarify your insurance coverage when receiving services by an Out-Of-Network Provider psychotherapist and/or acupuncturist.

Insurance Preauthorization Form

  • If you have any questions please feel free to call me or email me:
    • email:  nathan@cnathanbergeron.com
    • h/o: 323. 850.6508
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