Amy Neal | SimplePractice

Amy Neal Send Message

Your info

First name

Last name

Phone

Name you go by

Date of birth

Location at time of sessions:

I am only able to work with clients in North Carolina and Washington state. At this time, I am only offering virtual/telehealth sessions. Please indicate what state you will be in at the time of sessions.

Is there anything that the practitioner needs to know?

Reason for care

Who is seeking care:

Myself Someone else

What needs or struggles would you like to address in therapy?

Limited to 600 characters

Referral source/ How did you hear about me?

Preferred appointment times- My current schedule is 8:30-2:00 (last session starts at 2, ends 3:00pm)

Billing & Payment

Insurance details

Please select your insurance plan. Please note that I am not in network with any of the Medicaid or Medicare plans. I am also not In Network with Blue Local or Blue Home.

Aetna BCBS United/ UMR/Optum/Oscar/Oxford Cigna Amerihealth Next (Marketplace, not Medicaid) Self-pay - $185 Uninsured Other

Insurance card upload

Upload a photo of your insurance card

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.