Please read/review each section and check the box under each section to acknowledge/confirm that you understand and agree. Once all sections are checked, you will then be directed to a link to submit your information.
Dr. Banda offers testing for patients ages 24 and under only. She is in network with UPMC insurance only (please see details below under Insurance. Dr. LaPointe offers testing for ages 13 and older. She is in network with UPMC insurance only (please see details below under Insurance.
Dr. Banda and Dr. LaPointe are in-network with UPMC and only accept commercial, employer-sponsored or plans purchased through the Market Place. We do NOT accept UPMC For You, UPMC For Life, Medicaid/Medical Assistance, Medicare or any other commercial insurance plan.
For In Network patients (UPMC commercial, employer sponsored, or a plan purchased through the Market Place), this is billed directly to your insurance however you are responsible for payment of any copay and/or member cost share/deductibles, and any services not covered by your insurance, according to the terms and benefits of your insurance plan.
The cost of the clinical intake is $225.
An assessment package will be decided on after the intake is completed and the assessor knows how best to meet your assessment needs.
The feedback session is included in the total cost of the evaluation; therefore, no additional payment is due at the conclusion of testing.
INTAKE, TESTING AND FEEDBACK/FOLLOW-UP:
Intake details, 90 minutes, via Virtual/Telehealth:
The Examiner will gather information to understand the reason for testing so a plan for the assessment can be established.
Children 13 and younger do not have to be present
Children 14 to 17 can be present, but do not have to be if scheduling interferes with school and they do not want to miss
18-years-old and still in high school/college students: they have to consent themselves so need an email address so THEY receive the intake paperwork, but Dr. Banda still prefers that parents be a part of the intake.
Testing details, approximately 4 hours, in Person:
Children 6 and younger: parent should remain in the waiting room
Children 7 and older: parents can drop off and the Examiner will send a text when testing is close to being completed. Parents are also welcomed to wait if they/their child prefers.
Only one parent is allowed to wait.
As a reminder, we are in network with UPMC and ONLY accept commercial, employer sponsored, or plans purchased through the Market Place. NO CHIP, KIDS, UPMC For You (Medicaid/Medical Assistance) or UPMC For Life (Medicare) plans.
Please complete this section if you are age 26 or younger and are covered/utilizing your parent's insurance for services.
*Only if parents are separated/divorced and patient is age 18 or younger and both parents need to consent for services*
*If known, please check all that apply.
*Please check all that apply.
*Can select none or both.
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