Jennifer S. Battaglino, LCSW

178 Myrtle Boulevard, Larchmont, New York 10538

© 2023 - all rights reserved

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914-315-4044 / Fax 914-315-8266

jb@jenniferbattaglino.com

FORMS

The following forms can be printed and filled out in advance or available to you at your first session.   

All clients must fill out and sign the Client Information and Bill of Rights Form

If you would like to find out if you can receive some reimbursement through insurance, please contact my office or you can send me the information on the insurance form so that we can verify coverage.

I am an out-of-network provider for all insurance carriers except for Medicare.

I am an in-network provider for Medicare.

Please contact me with any questions.  Thank you

Client Information

Client Bill of Rights - HIPAA

Health Insurance Information

Permission to Bill Health Insurance Company

Release of Confidential Information