Forms and Payment Information

Dr. Hinkle is a provider for a number of insurance networks. If you hope to use insurance to help to pay for your sessions, please check with your carrier to see if Dr. Hinkle is in network for you, what your coverage is, and if your policy requires referral or preauthorization for outpatient mental health services. If your sessions are covered by insurance, you will be asked to pay your copay/co-insurance/deductible amount owed at the time of service. Dr. Hinkle contracts with a billing service which will bill your insurance and then send you a statement for any unpaid balances. If you will be paying out of pocket, please call the office for the current fee schedule. Cash, check, or VISA/MasterCard/Discover/American Express are accepted.

Please come 15 minutes early to your first appointment to complete paperwork, or download and complete the registration form and signature page from the services description and agreement (below), and bring with you to your first appointment. You may also return these forms via encrypted email if Dr. Hinkle sent them to you.

Registration Form - form for general information about you and your insurance.

Services Description and Agreement - agreement for services and privacy notice.

Authorization Form- This is the Authorization to Release Information.

Privacy Notice - HIPAA privacy notice.

Nondiscrimination Notice - IHCP Nondiscrimination Notice

Informed Consent for TelePsychology

Office Disclosure Notice Against Surprise Medical Billing

Good Faith Estimate Notice

Secure Form for Sending Medical Records

Contact Me

Completing this form does not create a psychologist-patient relationship.





10:00 am-6:00 pm


10:00 am-6:00 pm


10:00 am-6:00 pm


10:00 am-6:00 pm