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Forms

Informed Consent & Authorization   for Psychotherapy

Telehealth Consent

Release Exchange of Information Form

Intake Form

In Network with Following Providers:

  • Aetna

  • Beacon Health Options | Carelon

  • Blue Shield

  • BlueCross and BlueShield

  • Cigna

  • GEHA

  • Gold Coast Health Plan

  • Magellan

  • MHNet Behavioral Health

  • Optum

  • TRICARE

  • TriWest

  • UMR

  • United Behavioral Health Plan, CA

  • UnitedHealthcare UHC | UBH

  • Ventura County Health Plan

Email: amendozamccoy@yahoo.com

Phone:  805-280-5129

  • Instagram

© 2035 by Annette Mendoza-McCoy 

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