Forms & Insurance
Please download and complete our intake packets and wellness forms. You may submit them below, e-mail them to firstname.lastname@example.org or bring them with you completed to your visit. Filling out these forms will greatly reduce waiting times. Thank you for choosing us and we hope to see you soon.
***Forms Require Adobe Acrobat in Order to View or fill out on your local computer as well as to Print. Click here for Adobe
See below to download individual New Patient Forms
download the packet containing the intake forms and behavioral forms
After you have filled out a form, be sure to save it. Then, please use the drop box provided here to submit your completed form(s).
> Blue Cross / Blue Shield
> Optum/United Behavioral Health
> State Employees Health Plan
> United Healthcare
*Full payment is due at the time of service.
Please contact your insurance company to determine your policies benefit coverage for Mental/Behavioral Health/Substance Abuse in an office place of service (outpatient) setting.
EAP: We are contracted with several companies Employee Assistance Programs (EAP). Please provide the EAP group name, company name, authorization number and forms for reimbursement.
For questions about the forms or insurance, you may call Jennifer Latsha, our Practice Manager with One-Eighty Counseling and she will assist you, or you may call your insurance provider directly.
Fax: (919) 772-1978
69 Shipwash Drive
Garner, NC 27529
Fax: (919) 462-0433
113 Edinburgh South Drive, Suite 130
Cary, NC 27511