New Patient Form
If possible please fill out this form and bring it to your first appointment.
Release of Information
The Release of Information form might be necessary if you are referred by another professional and want Dr. Bonner to communicate with that person regarding your care.
Medicare Private Contract
The Medicare Private Contract is necessary if you are covered by Medicare. Dr. Bonner does not participate in Medicare and all fees associated with her services are the sole responsibility of the patient.
Fees and Insurance
Dr. Bonner is an out of network provider for all insurance. Payment is expected at the time of your appointment unless other arrangements have been made. Dr. Bonner can provide you with the necessary paperwork to file with your insurance company.
Privacy and Confidentiality
The doctor/patient relationship is confidential and protected by law. Both written notes and verbal communications cannot be released without the patient’s (or legal guardian’s) consent. However, according to federal and state laws, physicians and mental health professionals are mandated to report child and elder/vulnerable adult abuse. In addition, if a physician determines that a patient presents “imminent danger to self or others,” there are legal provisions for involuntary hospitalization.