Dr. Marni Greenberg | Forms & Payment
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To save time, you may read and sign your forms ahead of time and bring them with you to your first appointment.

If you are an adult attending your first individual appointment, please complete the following forms:

New Patient Information

Receipt of HIPAA Privacy Procedures and Policies

Privacy Policy Statement (You keep this form)

Consent Form


If you are the parent of a child or teen, please complete the forms above in addition to these:

Minor Consent Form

Parent Questionnaire



Insurance & Payment Information

I am an in-network provider with the following insurance plans:
Anthem Blue Cross
Blue Shield/Magellan


If I am an out-of-network provider with your insurance plan, I can still bill your insurance for you if you have a PPO with out-of-network benefits. To find out, you can call your insurance provider and ask them about your out-of-network behavioral/mental health deductible and copayment/co-insurance.


I can also offer a sliding scale fee based upon your income.


Please feel free to contact me with any questions.