Forms and Logistics for the Somatic Psychotherapy practice of Fern Snogren, LCSW, MA, CHT

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Clients

Professional Disclosure Statement

Professional Disclosure Statement: Medicaid Clients

New Client Info Form

Insurance Information Form

In-Network Insurance Use and Billing Agreement

Out-of-Network Insurance Use and Billing Agreement

Release of Confidentiality

Professional Disclosure Statement for Non-Clients

Gender Dysphoria Questionnaire

Supervisees

Clinical Supervision Professional Disclosure Statement

Payment Options

Insurance billing for insurances with which I am in network:

AllCare PEBB

Asante

Blue Cross Blue Shield

Bridgespan/Real Value

Coventry

First Choice

Health Comp

Health Net (MHN)

OHP: Jackson Care Connect & AllCare

Medicare & all Medicare Advantage Plans

Moda

Pacific Source

Regence Medicare Advantage (MedAdvantage PPO)

Reliant EAP (includes Samaritan & Asante)

Wellness 2000 EAP

Monthly superbills for clients with insurances with which I am not contracted

Fees are reviewed and established annually and are available upon request.

Session Length

Sessions range from 45 to 90 minutes, depending on client needs, insurance billing restrictions, affordability, and the specific nature of work we are doing.

More Information

For more information, please consult my Professional Disclosure Statement or feel free to call 541-482-3328 or email info@fernsnogren.com. Please include in your correspondence with me what, if any, insurance you plan to use.