top of page

Please open the PDF file to print and complete. 

Payment/insurance: I am a fee for service practice. Payment is expected (cash, check, credit card), in full, at the time of service. I do not participate in any insurance plans or accept assignment from insurance companies, but will provide you with the appropriate documentation so that you are able to submit claims to your insurance companies for reimbursement, under the provisions of your plan for out-of-network services. I am happy to help complete any documentation needed for you to submit claims to your insurance company.

100 Park Ave, Suite 105   Rockville, MD   20850                     301-610-5400                                          psych@llenhartphdllc.com

bottom of page