New Patients
If you are interested in becoming a new patient in this office, you will need to first confirm availability. Please send email message to Michael E. Roback, LCSW or call the office at 310-472-3385 and describe your current concerns, and the assistance that you are seeking as well as providing the name of your health care insurance company or employee assistance benefit. You will be contacted with more information. If you received confirmation of availability, please proceed to prescheduling steps below.
Once availability has been confirmed, please complete the prescheduling steps below, navigating all green links, in the following order. You will first need to complete Step 1-3 and then complete ONE paperwork set that corresponds to your plan below and RETURN. Note, for couples, each partner needs to complete and return a set. Please keep office informed as to your progress with this. If you need assistance completing the paperwork, please feel free to download Adobe Fill & Sign IOS or Adobe Fill & Sign Android . This is an excellent no-cost PDF application that is very user friendly. If you are seeking to use your health care insurance company to cover some of the cost of your treatment, please contact them for benefit information. Please follow and complete this GUIDE, and RETURN. If it is determined that you have an out of pocket responsibility, you will be sent a request for your session cost via a banking interface, either by message or email contact. At the time of your first scheduled appointment, please navigate to telehealth platform, and wait in the virtual waiting room until greeted.
Patient Demographic and Insurance Form and If you have insurance card, please SEND copy (front and back).
COMPLETE NEW PATIENT PAPERWORK AND RETURN - CLICK YOUR PLAN LINK
TRADITIONAL HEALTH CARE INSURANCE PLANS
Standard Insurance New Patient Paperwork - Individuals
EMPLOYER SPONSORED EMPLOYEE ASSISTANCE PROGRAMS (EAP)
Anthem Blue Cross EAP New Patient Paperwork - Individuals
Concern EAP New Patient Paperwork - Individuals
Concern EAP New Patient Paperwork - Couples
LYRA New Patient Paperwork - Individuals
LYRA New Patient Paperwork - Couples
Wellspring EAP New Patient Paperwork - Individuals
Wellspring EAP New Patient Paperwork - Couples