This disclaimer should be included with the Good Faith Estimate (GFE) you provide to uninsured patients.

This document includes typical CPT codes used by mental health clinicians, including routine psychotherapy and testing codes.

Complete and return this form to SimiTree Behavioral Health whenever there is a change in your mailing or physical office addresses. Due to payer update timeframes, we ask that you provide this form 30-60 days before the change of address.

If you need to update or change the credit card you have on file, please complete the attached form and send it through our secure portal.

Complete this form yearly to ensure that we have the most up-to-date information on file for your practice.