Red Elm Psychology, Counseling & Evaluation Services

Red Elm Psychology, Counseling & Evaluation Services Send Message

Who would be receiving care?

Someone else

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Last name

Phone

Name you go by

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State

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Home Address:

School District (if applicable)

Reason for care

What are your primary concerns that led you to seek counseling or evaluation services at this time

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What services are being sought?

Counseling Psychological Evaluation Other Not sure

Administrative

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Billing & Payment

Insurance & Payment details

Dr. Melissa Dudley accepts the following commercial insurance plans. She is not able to see individuals with Medicaid/Medicare managed plans at this time. Please check form payment from the options listed below:

Excellus Blue Cross Blue Shield (except plans with the following prefixes VYT, VYH, VYB, YNC) Highmark Blue Cross Blue Shield Independent Health MVP Healthcare Univera Healthcare Self-Pay

Insurance card upload

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Client Preferences

Preferred appointment times

Morning Afternoon Evening

Preferred modality

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.