Dr. Barbara Bear

 Adolescent, Young Adult, and Adult Psychological Services

Educational and Career Consultant, Executive Coach, Organizational Psychologist, Certified Autism Specialist, Master of Jurisprudence in Child Law and Policy

Client Information Form

Please go to https://drbarbarabear.clientsecure.me/ to access my secure portal to input your information and make an appointment. Otherwise, you may use this format. 

BY CLICKING SUBMIT: I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment. I also authorize payment of medical benefits to the undersigned physician or supplier for services. 

PLEASE BRING A COPY OF YOUR INSURANCE CARD TO YOUR APPOINTMENT. Please be advised that you will be responsible for payment should your insurance refuse to pay for services rendered.