New to Cummins
Are you new to Cummins and want to be prepared for the first time you come into our office? As a first-time consumer, we will need you to complete some forms as well as bring certain paperwork with you to your first appointment. Should you have any additional questions, please call our office at 888-714-1927.
Forms To Complete
- New Consumer Registration Form – Child (Age 2-17)
- New Consumer Registration Form – Adult (Age 18+)
- Spanish: New Consumer Registration Form – Child (Age 2-17)
- Spanish: New Consumer Registration Form – Adult (Age 18+)
- Consent to Treat and Telemedicine Form
- Spanish: Consent to Treat and Telemedicine Form
- Treatment Plan Signature Form
- Child Transportation Form
General Appointment Information
- A parent or legal guardian is required to attend the appointment of any minor consumer (less than 18 years of age).
- Call your insurance company BEFORE your appointment.
- Request to specifically speak with a representative regarding your “Behavioral Health benefits”.
- Many Behavioral Health benefits are managed by a different insurance carrier than your medical carrier. This is referred to as a “carve out”.
- Verify your visits and services at Cummins Behavioral Health Systems, Inc. will be covered by your plan.
- You will be responsible for the balance of any services not covered by your insurance.
- What To Bring Checklist
- Insurance Card
- Photo ID (if available)
New Consumer Registration information (to be completed online)
- Copy of your most recent Federal Income Tax Return to apply for reduced fees for services not covered by insurance
- A list of all medicines; prescription and over the counter (name, dose, and frequency taken) that you are currently taking
- A list of any medications that you have allergies to or have experienced an adverse reaction to in the past
- Any documents that might be pertinent to your treatment (previous psychological testing, hospital discharge summaries, recent laboratory results, etc.)