forms

Links to HIPAA-compliant secure forms

Forms for clients & families

APPOINTMENT REQUEST FORM click here to request an appointment

Upload documents — to securely upload documents for us to review.
Release of Information — to be used to allow us to contact others in regards to your care.
Winston Center Privacy Practices — for HIPAA related information

Forms for teachers

The forms listed below are for teachers to provide us with information on how your child is performing at school.

Teacher Initial Questionnaire – To be done the first time the teacher completes a questionnaire for a
particular student. At subsequent times, use the Follow-Up Questionnaire.

Teacher Follow-Up Questionnaire – For follow-up questionnaires you do not need to complete all fields, just those you feel are pertinent.

insurance

We are in net-work with the following insurance companies:

Aetna  

Asuris  

Premera

Blue Cross Blue Shield 

Blue Cross of Idaho

Cigna - we will be out of network as of January 1, 2020

EBMS  

First Choice Health

First Health Network

GEHA

HMA

Kaiser PPO (we are not contracted with CORE)

Lifewise  

Regence

Rehn & Associates  

Tricare

Trusteed

Uniform Medical Plan (SEBB)

Web TPA

Premera cards with prefix PBQ  (Reading/Writing/Speech services)

** Providence Hospital/Medical Network outsourced their mental health benefits to Providence Behavioral Health, aka Optum, which we are not contracted with


If you do not have the insurance listed above, you may have out-of-network benefits. Call your insurance company to verify benefits. Out of network patients are considered self-pay and payment in full at time of service is required. We are not in network with Medicaid, Medicare, Apple Health, or any state plan.