PsychBiller, LLC

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Provider Forms

The following forms are provided as a convenience to our clients.  We cannot guarantee that any form is the most current version, nor that it will be accepted by an insurance company.

Most forms are PDF files; the remainder are Microsoft Word documents.  The free Adobe Reader (version 5.x minimum) is required to view, fill in, and print PDF forms.  If you don’t have Adobe Reader installed on your computer or need to upgrade your copy, click the button below to go to the Adobe Reader download site:

Get Adobe Reader

When you click on one of the underlined links below, the form will be displayed in your Web browser.  To print the form, click the printer icon on the Adobe Reader toolbar just above the top of the form (not your Internet browser’s toolbar).


Authorization Request and Treatment Plan Forms