New Patient Forms

Please download, review and complete the following forms. Click here for instructions on how to complete patient paperwork.

• INSTRUCTIONS - Instructions on how to complete patient paperwork
• FORM - 1 Adult Patient Information Form (Ages 18+)
• FORM - 2 Child/Adolescent Patient Information Form (Ages 17 and under)
• FORM - 3 Authorization for Use and Disclosure of PHI
• FORM - 4 Telehealth Informed Consent
• FORM - 5 Notice of Privacy Practices

Insurance Questions

Graven & Associates, PLLC takes a variety of insurance. However, it is your responsibility to check with your insurance carrier to understand your benefits and coverage of service. Ask your carrier questions such as:

• Do I have mental health benefits?
• Do I have a deductible and has it been fulfilled?
• Do I have a copay?
• What type of treatment does my plan cover?
• Does my plan exclude treatment for a specific diagnosis?
• Do I need a referral from my physician?
• Does my plan pay for an out-of-network provider? If so, how much?
• How many sessions does my plan allow?

Appointment Policy

Graven & Associates, PLLC and our providers enjoy working with our patients and we appreciate that you have entrusted us to provide you with the best quality of care. We take our roles as your provider seriously and will ensure you are given our full attention during your scheduled visits. Time is an important factor to everyone. Our providers are on time for appointments and we ask that you respectively do the same.

Graven & Associates, PLLC has a 48-hour cancellation policy. If you do not show up for an appointment or fail to cancel your appointment within 48 hours of your scheduled time you will be charged a fee. If you cancel a therapy appointment without a 48-hour notice or miss an appointment, you will be charged $90. If you cancel a testing appointment without a 48-hour notice or miss an appointment, you will be charged $90 per hour you were scheduled to be in the office. Only in certain circumstances will the fee be waived.

Patient Accounting and Billing

For patient accounting and billing questions please contact our accounting office. They can be reached at:

General Phone: 219-926-8320
Fax: 219-926-3524
Email: accountquestions@ascendpm1.com

Mailing Address for payments and/or other correspondence: