Client Forms

Update Your Payment Method Here: View Form

This form is used to gather credit card information and grant Larch permission to keep it on file for future appointments.

Release to Bill Insurance Information – Intakes (For new clients): View Form

This form is used to gather insurance information and grant Larch permission to submit electronic claims on your behalf for possible out of network reimbursement.

Update Release to Bill Insurance Information (For Current Clients): View Form

This form is used to gather insurance information and grant Larch permission to submit electronic claims on your behalf for possible out of network reimbursement.

Requesting Statement/Superbill: View Form

This form is used to request a statement for accounting purposes, or requesting a superbill for submitting for  claims for possible out of network reimbursement if allowed and we are not already submitting on your behalf electronically. If you are requesting a superbill, please first visit our FAQs page (link in menu at top of page) and read through our insurance policies and superbill policies. Superbills are only to be requested AFTER you were told we cannot submit electronically AND after you got confirmation from your insurance company that they will reimburse for out of network service with your therapist. We will not produce superbills if we know your insurance company does not reimburse or we are already submitting.