Welcome to Claytor memorial clinic

Welcome to Claytor memorial clinicWelcome to Claytor memorial clinicWelcome to Claytor memorial clinic

Welcome to Claytor memorial clinic

Welcome to Claytor memorial clinicWelcome to Claytor memorial clinicWelcome to Claytor memorial clinic
  • Home
  • Meet the Providers
  • Meet the Staff
  • Blog
  • Locations
  • Forms/Insurance/Billing
  • Resources
  • More
    • Home
    • Meet the Providers
    • Meet the Staff
    • Blog
    • Locations
    • Forms/Insurance/Billing
    • Resources

  • Home
  • Meet the Providers
  • Meet the Staff
  • Blog
  • Locations
  • Forms/Insurance/Billing
  • Resources

New Patient Forms

Please have the following forms filled out and returned to us before making an appointment.

  • Permission to treat
  • Authorization to Release Health Records
  • Child Psych Background Info, Adult Psych if over 18 years old
  • The last page of the Practice Parameter signed due to the parameters being something for you to keep

(Referral form only needs to be filled out by referral source)

Thank you!

Referral Form (pdf)

Download

Permisson to Treat (pdf)

Download

Authorization to Release Health Records (pdf)

Download

Practice Parameter (pdf)

Download

Child Psych Background Info (pdf)

Download

Adult Psych Background Info (pdf)

Download

Insurance

Insurance Accepted

Running out of Medication?

Insurance Accepted

  Commercial:

  • Aetna
  • Anthem 
  • Beacon Health
  • Cigna
  • Tricare/Humana
  • Optima
  • Optum 

Medicaid:

  • Anthem Healthkeepers  Plus
  • Aetna Better Health
  • Magellan CCC
  • Medicaid of VA
  • Optima CCC
  • VA Premier
  • VA Premier Elite Plus
  • UHC CCC

Insurance Changes

Running out of Medication?

Insurance Accepted

  Please be aware that when insurance changes, most new insurances will require a prior authorization for medications. This means they will accept or not accept the medication being prescribed and/or pay for it. Please give us at least 3-5 days to get a prior authorization done for the medication.   

Running out of Medication?

Running out of Medication?

Running out of Medication?

 Please let us know at least a week ahead of time before the patient runs out of medication.  

Billing

Pay your bill online

You may also contact the office at extension 204 to speak with Tammy Credille, billing specialist.

Click here

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