Melissa E. Mendoza, LMSW

2nd: Receive Benefits Quote in Welcome Message w/ Scheduled Intake Appointment Details

SAVE Melissa E. Mendoza, LMSW's 📱Cell Phone Contact

😊 Meet Melissa

☂️Aetna, BCBS, Blue Care Network, Priority Health, HAP, Cigna / Evernorth, Optum, ect.

www.PinkPsy.com

*Payment Authorization Form (Read & Sign)

*Consent for Treatment Form (Read & Sign)

*Telehealth Consent Form (Read & Sign)

*HIPAA Privacy Notice Form (Read & Sign)

*Client Snapshot (Read & Sign)

BECK DEPRESSION INVENTORY

BECK ANXIETY INVENTORY

Rough Day/Week? I'm happy to support - just text to inquire about adding an extra needed session.

If you feel that you may be of harm to yourself or someone else, please call 911 and go to the closest emergency room. The National Suicide Prevention Lifeline is 1-800-273-8255.

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LOCAL PSYCHIATRIST: Thomas Park, M.D.

Late Reschedule / Cancellation Policy

CURRENT CLIENTS: UPDATE MEDICATIONS FORM

CURRENT CLIENT: CHANGE of Information Request Form UPDATE/S: FIRST Name l LAST Name l Phone Number l E-Mail Address l Emergency Contact l Address

CURRENT CLIENTS: Updated Client Symptom Snapshot

Friendly Reminder: Do Self Breast Exams Every 30-Days / How to Do Self-Breast Exams (Enter Here) / Early Detection Saves Lives / Tests & Procedures to Diagnose Breast Cancer: Self Breast Exams l Yearly Mammograms l Breast Ultra Sound l Breast MRI