While Rogue River Counseling does not accept or work in conjunction with insurance carriers, one of the services we provide is to submit your Insurance claims electronically once a month. Many insurance carriers may reimburse you for part of your out-of-network expenses. If you would like us to submit your claims electronically please fill out and submit this form. When you arrive to your first appointment, provide us with a copy of your insurance card and driver’s license.

Be sure to read and accept the Disclosure Statement at the end of this form.