Deborah Lyman

LCSW


NOTE: Please make a copy of the front and back of your insurance card(s) and email the images to Deborah Lyman HERE.


Insurance Authorization

Middle
(Street & Number or P.O.)
(if different than client)

(if different than client)
Deborah Lyman, LCSW, has my permission to communicate with my insurance company and to provide information necessary for the purposes of obtaining authorization for services, provision of services and coordination of care. Deborah Lyman, LCSW, or the billing service contracted with Deborah Lyman, LCSW, has my permission to bill my insurance company and to provide necessary information for the purposes of obtaining authorization for services, benefits information and payment.