DR. GOLD'S CLIENTS ONLY

If you're a first-time client, please review and complete the following forms, bring them to your first session.

• Client Intake Form
• Policies and Consent to Treatment
• Insurance Form (if you have AZ Foundation or Aetna Ins. ONLY)

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

• Consent to Release Information Form

If you have NO INSURANCE (not AZ Foundation, Aetna, or out-of-network coverage), I have a sliding scale to determine my fee. It is based on family size (number of dependents and guardians living in same household) and income. 

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