Forms

This form is required for your first visit. I invite you to print and fill out this form before your first appointment so as to make sure that you have filled in every detail you are aware of.


Click on "Auto Accident Intake Form" to the left of this paragraph to access the form in a new window. 

If you have been involved in an auto accident, please fill out this form. Please note that I cannot accept health insurance plans such as Highmark or UPMC, only auto insurance. When filling out the second page, I will need your auto insurance information, as well as the information for the auto insurance I will be billing, if it is different from yours. Please write the claim number for your accident at the top of the form. 


Forms can either be printed and brought with you to your first session, or you can scan and e-mail them directly to me if it is more convenient. Please contact me with any questions you might have.

jeanettellmt@gmail.com

412-445-6769