New Patient Forms
If you are a new client, or interested in becoming one, please complete the following forms and bring them to our first therapy session.
I prefer all clients who can to complete the following questionnaire and review and print the cancellation policy.
Telehealth Informed Consent - please familiarize yourself and sign prior to using doxy.me
Please take a moment to familiarize yourself with our HIPAA/Psychotherapy Agreement Form, Electronic Communication Form, as well as the PA Notice Form.
If you are using insurance please email pictures of BOTH SIDES of your insurance card to vatsala @drmilbourne.com or greg@drmilbourne.com. Thank you.
If you would like your care coordinated with another provider (for example, your psychiatrist or primary care physician), complete this form to authorize release of psychotherapy information or this release form. It is a good idea, which I encourage clients to complete.
Personal Choice or Keystone HealthPlan East clients, managed by Magellan, should complete this form as well.
Carebridge EAP clients should bring this form to the first session.
EMDR workbook for preparation to work on anxiety, depression and trauma.
Dr milbourne's standard office hours are Currently entirely online via https://doxy.me/drmilbourne
Monday 10:30am-6:30pm
Tuesday 7:30am-6:30pm
Wednesday 7:30am-6:30pm
Thursday - 7:30am-5pm
Friday 7:30am-2pm
Dr Milbourne is able to provide telepsychology services in the following states (client MUST be located in one of these states at the time of service):
Alabama
Arizona
Arkansas
Colorado
Delaware
Georgia
Illinois
Kansas
Kentucky
Minnesota
Missouri
Nebraska
New Hampshire
Nevada
North Carolina
Ohio
Oklahoma
Pennsylvania
Texas
Utah
Virginia
Washington (starting June 2022)
West Virginia
CLick here to connect to the Therapy Portal where you can schedule and change appointments and add other personal information to your record.
NPI: 1598841314