Dr. Barbara Bear

Child, Adolescent and Adult Psychological Services

Client Information Form

BY CLICKING SUBMIT: I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment. I also authorize payment of medical benefits to the undersigned physician or supplier for services. 


PLEASE BRING A COPY OF YOUR INSURANCE CARD TO YOUR APPOINTMENT. Please be advised that you will be responsible for payment should your insurance refuse to pay for services rendered. 

Dr. Barbara Bear Licensed Counselor in Greensboro North Carolina Specializing in Women's issues