The Federal “No Surprises Act” took effect January 1, 2022. All healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing.” To learn more about the “No Surprises Act” and our responsibilities to you, click the image!
Welcome!
Dr. Brenda Danielson brings over 10 years of experience as a Licensed Clinical Psychologist to BBHW. Dr. Danielson addresses a broad spectrum of issues ranging from substance use and abuse, chronic pain, insomnia, PTSD and trauma to gender dysphoria and multiple co-occurring discorders.
Teletherapy
The No Surprises Act
If you are an existing client, or new to the practice, please download the following three (3) forms, fill them in, and return them to Barrington Behavioral Health and Wellness prior to your next appointment.
No Surprises Letter
Download this letter to learn our responsibilty to you under the No Surprises Act.
Good Faith Estimate
Download this form for your reference and your therapist will discuss this with you.
Estimate Fee Schedule
Download this reference table of fees for service. Number of sessions TBD with your clinician.
Private Pay Contract
If you intend to pay “Out Of Pocket” (fee for service), download this form and complete it and remit it to BBHW prior to your next appointment.
If you are a new or existing client and have questions regarding the “No Surprises Act” you may, please call or email Barrington Behavioral Health & Wellness.
Phone: 1-888-261-2178
Email: help@barringtonbhw.com
Good Faith Estimate
Download this form for your reference and your therapist will discuss this with you.
Good Faith Estimate
Download this form for your reference and your therapist will discuss this with you.
Good Faith Estimate Fee Schedule
Download this reference table of fees for service. Number of sessions TBD with your clinician.
Private Pay Financial Contract
If you are a “fee for service” or intend to pay “Out Of Pocket”, download this form and complete it and remit it to BBHW prior to your next appointment.
Good Faith Estimate
Download this form for your reference and your therapist will discuss this with you.
Good Faith Estimate
Download this form for your reference and your therapist will discuss this with you.
Good Faith Estimate Fee Schedule
Download this reference table of fees for service. Number of sessions TBD with your clinician.
Private Pay Financial Contract
If you are a “fee for service” or intend to pay “Out Of Pocket”, download this form and complete it and remit it to BBHW prior to your next appointment.
Good Faith Estimate Fee Schedule
Download this reference table of fees for service. Number of sessions TBD with your clinician.
Private Pay Financial Contract
If you are a “fee for service” or intend to pay “Out Of Pocket”, download this form and complete it and remit it to BBHW prior to your next appointment.
All clients must fill out this form and bring it with them to their first appointment.
If bringing a minor, please fill out this form and bring it to the first appointment.
All clients must fill out this form and bring it with them to their first appointment.
All clients must fill out this form and bring it with them to their first appointment.
Your rights under the Health Information Portability and Accountability Act
All the Child and Adolescent forms in one ‘zip’ file!
