Dr. Washington Harvey will have you complete several forms and provide you with a consultation and brief orientation to her practice that explains her approach to treatment. You will also have an opportunity to explain your reasons for seeking her help and what you would like to see happen as result of treatment. If you wish you can download and complete the following forms and bring them with you to your first visit to save some time.

Private insurance is accepted as a form of payment but is subject to verification of coverage. Dr. Washington Harvey is an in-network provider for several major insurance companies. It is the client’s responsibility to pay any co-pays at each visit. Clients are also responsible for payment of any and all charges that are not covered by his or her insurance.

Medicare or Medicaid is not accepted at this time.

(Note: A sliding fee scale is available for some clients and is subject to income verification.)

Forms:

Patient Information and/or Orientation

Patient information Form –  ( Write in Form | Editable Form )
Patient Orientation –  ( Download please print and sign )

Individual and/or Family Member

Behavior Assessment – Individual –  ( Write in Form | Editable Form )
Behavior Assessment – Family Member –  ( Write in Form | Editable Form )

Problem Gambler and/or Family Member

Gambling Intake Assessment – Gambler –  ( Write in Form | Editable Form )

South Oaks Gambling Screen (SOGS)  –  ( Write in Form | Editable Form )
Gambling Assessment – Family Member –  ( Write in Form | Editable Form )
GAM Anon 20 Questions – Family Member –  ( Write in Form | Editable Form )