Surgery Clearance Information

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WELCOME

Thank you for allowing me to assist you on your weight loss journey.  I am very excited to be part of your process.

 

GENERAL INFORMATION

Here are the steps that you need to take to schedule an appointment:

1. Make an Appointment: Schedule an Appointment below

2. Intake Packet: Complete and return Intake Packet at least 24 hours in advance of appointment time

3. Pay for Evaluation : If you are NOT a KAISER, PRIMECARE OR CROWN SURGICAL patient , you will need to pay for your Evaluation.    If you would like a SuperBill to file with your insurance company, please complete it and return it to me in your packet, I'll sign it and send it to you once your Evaluation has been completed.  ill.

4. Attend telehealth session: Click the below icon to sign in to your appointment and begin your telehealth session on the day and time of your appointment.  You cal also follow the instructions in your packet to connect.

SCHEDULE AN APPOINTMENT

PLEASE ONLY BOOK ONE TIME SLOT.  IF YOU BOOK MORE THAN ONE SLOT, YOU WILL BE CHARGED FOR THE SECOND SLOT. All appointments will take place on a Telehealth HIPPA compliant platform. Please  click the icon below to start your session.

COMPLETE YOUR PAPERWORK

All the necessary paperwork can be typed on the forms or you can print out the packet and send it to me.  You can print the packet  by downloading it from the link below:

Please click on the tab above to open the documents.  These documents can be filled in without printing them out.  When you complete the packet please "save as" your complete name and save to your computer.  You can then email that new file back to our office.  PLEASE EMAIL THE COMPLETED PACKET TO: [email protected] Please put your name and the words "completed packet" in the subject line of the email.  If we don't receive your completed packet at least 24 hours in advance of your appointment, your appointment will be cancelled and you will be charged.


PAY FOR EVALUATION

KAISER, CROWN SURGICAL OR PRIMECARE PATIENTS

If you are a Kaiser, Crown Surgical or Primecare patient, there is no charge for the Evaluation.  PLEASE INDICATE KAISER, CROWN OR PRIMECARE IN THE PAYMENT SECTION OF THE INTAKE PACKET.

ALL OTHER PATIENTS

YOU WILL NEED TO PAY THE $150 EVALUATION FEE.   Please include a credit or debit card in the authorization section of the paperwork. If you would like a SuperBill to file with your insurance company, please complete it and return it with your paperwork, our office will sign it and send it back to you.

Appointments that are cancelled without a 48-hou r advance notice may be subject to a full session fee charge. Appointments who haven't submitted Intake Documents and Payment (no payment if you are a Kaiser, Primecare or Crown Surgical patient) 24 hours in advance of their appointment date, will be charged a full Assessment fee and your appointment will be cancelled.
If you can't connect on your appointment date due to an error on your connection, you will be charged the full session fee.  Please do a test call with Doxy prior to your appointment date to ensure connection.  I will attempt to connect once.

VENMO INFORMATION


CONNECT YOUR SESSION

  SHARON D. HEASTON, LMFT

PSYCHOLOGICAL CONSULTING SERVICES, INC.

(909) 945-8894

TELEHEALTH:  DOXY.ME/SH

EMAIL: (PREFERRED):  [email protected]

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