Birchwood Healing Place
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    ​Please note this form must be filled out in its entirety even if the answer is N/A, none, or no, Otherwise it will not allow you to submit the form. Once the form has been received someone from this office will reach out to you.

    We encourage you to contact member services with your insurance company prior to your first appointment and inquire about deductible, co-payment and or coinsurance for CPT code 90837. In the meantime put N/A if you do not know this information. All KY medicaid plans are 0.00 copay at this time.
    CPS stands for Child Protective Services.
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