This page last updated: 12/07/2007

Forms

 (in Adobe PDF format -download free reader)

	Client Demographic Information
	Client Medical History
	Confidentiality Policy
	Financial Agreement
	Insurance Form (if you wish to use health insurance)
	Policy information for Blue Cross - Blue Shield policyholders
Payment or Fee Questions?  Contact our billing service.

Back to Client Information Page

Phone: 910-509-7115

FAX: 910-509-7099

Email:

lporter@alliedpsych.com

Office Location:

Landfall Executive Center

1213 Culbreth Drive

Wilmington, NC 28405

Lee Porter, APRN-NP, CS, BCIA-C

Smart medicine for the mind.