Klaskin Therapy

Forms

It is customary practice to fill out some paper work prior to seeing a healthcare professional for the first time. This helps me get to know you better and also informs you about my office policy. If it is convenient for you, you can download the patient registration form and consent for videotaping form from this website, fill it out and bring it in, or you can fill it out at your first visit. All other forms can be filled out at my office.

Because of low fees that insurance companies allow, I am able to accept a certain amount of insurance clients. I work with most major ppo insurance carriers such as Blue Cross, Blue Shield, Aetna, Cigna, and Healthnet. If you would like to use your insurance it would be helpful if you would call your insurance carrier and find out about your out-patient psychotherapy benefits, any necessary authorizations, deductibles and co-pays. It would be also be helpful to make a copy of the front and back of your insurance card and bring it to our first meeting. Although I will assist you in using your insurance benefits, ultimately it is your responsibility that I get paid for my services.

To download the forms, click on the links below:

Patient Registration Form

Consent to Videotape Form

Thank you!

Melissa Klaskin, PhD, LCSW
Beverly Hills Therapy for children, adolescents, and adults
Phone: (310) 559-7315     Fax: (310) 271-1781
melissa@klaskintherapy.com
204 S. Beverly Drive Suite 107
Beverly Hills, CA 90212
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