CALL US : 1-248-225-6896
DEAF HELP HERE.
Deaf Help Here
Deaf Help Here provides special services to the D/deaf and hard of hearing community. We understand the core values of the Deaf Community and respect the uniqueness of each D/deaf and hard of hearing individual. We offer outpatient mental health services that are culturally sensitive and linguistically accessible allowing the client to select their communication preference.
New Patient Paperwork
To save time download a copy of the New Patient Paperwork and please bring it to your first appointment already filled out.
The forms you MUST bring are:
Intake Information Form
Release of Information Form
Authorization Form
Privacy HIPAA Policy Form
Informed Consent, Authorization & Financial Policy Form
Benefits Authorization Form
Also, please bring a copy of your insurance card.
Cancellation Policy
You must cancel your appointment via phone or e-mail 48 hours prior to your appointment or you will be charged. Please e-mail jawcoda@gmail.com.
Payment Information
Payments can be made with check or credit card. Please make all check payments out to
June Walatkiewicz, PLLC.
Insurance Companies
Currently we are accepting clients from the following insurance companies. If you do not see your insurance provider on this list feel free to contact us here.
DOWNLOAD PAPERWORK
INTAKE INFORMATION FORM
RELEASE OF INFORMATION
PRIVACY HIPAA POLICY FORM
INFORMED CONSENT, AUTHORIZATION &
FINANCIAL POLICY FORM
BENEFITS FORM
VIDEO THERAPY FORM
Adult Form
Child Form
Form available by request only
2010 - present
2010 - present
Blue Cross Blue Shield
Blue Care Network
Health Alliance Plan (HAP)
Value Options
Aetna
Magellan
Health Plus
Medicare
United Healthcare
Molina
