New Client Appointments

If you have a referral to a specific therapist, review the list of  MCPST Therapists to find the telephone extension listed after her or his name, then call the clinic at (608) 237-8000 and follow the instructions on our voice mail to leave a message in that therapist’s confidential voice mail.  Generally, the therapist will return your call on the same business day or within 24 hours.

If you do not have a referral to a specific therapist, please call our Office Assistant Denise at (608) 237-8000 x3.  She will help clarify which of our therapists might be helpful to you.  She will then connect you to that therapist’s confidential voice mail.

Each of our therapists do their own intakes and schedule their own appointments. When the therapist returns your call, she or he will ask about your concerns and give you an opportunity to ask questions of them as well.

Once you have made an appointment, Wisconsin Statutes require all clients to complete several forms before their first session.  Your therapist will ask you how you would like to get the forms.  For your convenience you can download a printable copy of each of the forms from this page or from our MCPST Forms page.  If you are not able to print the forms, please contact your therapist who will make them available to complete in our office 30 minutes prior to your intake appointment or arrange for you to pick up the forms from our office prior to the session to complete at home and bring in to your first session.  Please talk to your therapist if other arrangements need to be made.

If you are using health insurance, please bring your health insurance card and a photo ID to your first appointment.  We will need to make a copy of the photo ID and both sides of your insurance card at the time of your appointment.

If you are the parent or guardian of a minor child, please complete and sign the forms for the child.

Please download, print, read and complete the following forms per your therapist’s instructions and bring them with you to your first appointment.  Your therapist will review the forms with you in the session and answer any questions you have about them.

Eight Forms For New Clients Who Are Using Health Insurance:

  1. MCPST Billing-Insurance Information Form gives you information about MCPST clinic policies and procedures; fees for intake and ongoing psychotherapy sessions; private pay fee agreement; assignment of benefits for insurance; asks about client and insurance information, and explains information we may release to your insurance company with your permission per their requirement for coverage of services. (2 pages) Read, complete and sign all relevant sections of both pages.
  2. Credit Card Payment Authorization is a courtesy we offer our clients to have their copays and/or session fees charged directly to their credit card.  This form is optional and kept confidential and private. (1 page)
  3. MCPST Intake Questionnaire asks for information about you, the issues that bring you into the clinic and your treatment goals so that we can best provide services for you. (2 pages) Complete entire form.
  4. MCPST Informed Consent explains informed consent as a client in the clinic. (1 page) Read and sign.
  5. MCPST Health Insurance Portability and Accountability Act (HIPAA) Privacy Practices Form describes legal use and disclosure of health information. (4 pages) Read.
  6. Receipt of HIPAA Privacy Practices Form acknowledges that you have received and understand the HIPAA form. (1 page) Read and sign.
  7. MCPST Client Bill of Rights tells you your rights as a client in the clinic. (1 page) Read.
  8. MCPST Insurance Benefits Worksheet provides information and questions to ask your insurance company to get accurate information about your mental health benefits. (2 pages) Complete and use as reference when calling insurance company to clarify benefits.

Seven Forms For New Clients Who Are Paying Privately:

  1. MCPST Billing-Insurance Information Form gives you information about MCPST clinic policies and procedures; fees for intake and ongoing psychotherapy sessions; and private pay fee agreement. (2 pages) Read, complete and sign all relevant sections of both pages.
  2. Credit Card Payment Authorization is a courtesy we offer our clients to have their copays and/or session fees charged directly to their credit card.  This form is optional and kept confidential and private. (1 page)
  3. MCPST Intake Questionnaire asks for information about you, the issues that bring you into the clinic and your treatment goals so that we can best provide services for you. (2 pages) Complete entire form.
  4. MCPST Informed Consent explains informed consent as a client in the clinic. (1 page) Read and sign.
  5. MCPST Health Insurance Portability and Accountability Act (HIPAA) Privacy Practices Form describes legal use and disclosure of health information. (4 pages) Read.
  6. Receipt of HIPAA Privacy Practices Form acknowledges that you have received and understand the HIPAA form. (1 page) Read and sign.
  7. MCPST Client Bill of Rights tells you your rights as a client in the clinic. (1 page) Read.

Form Giving Permission for Client Information To Be  Released:

MCPST Authorization For Release of Information authorizes release of information to and from another person, for example psychiatrist or former therapist, for your benefit, i.e. in order to coordinate services for you. (1 page) Read and complete name, contact information and dates of contact for person with whom your therapist will share information. Your therapist will complete the rest of the form with you in their office.

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Midwest Center for Psychotherapy & Sex Therapy · 6300 University Avenue, Suite 125 · Middleton, WI 53562 · (P) 608-237-8000 · (F) 608-237-8005