A Mindful Path to Mental Health - Appointment Request

Carolina Bonilla Jacome MD

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Patient Information

About your Appointment Request

If you were are switching care from another psychiatrist to Dr. Bonilla, please request that your current or most recent psychiatrist send Dr. Bonilla a copy of your records. You may sign their release of information form, or ask us for one.

Health Care Information

If applicable

Insurance Information

If Dr. Bonilla is not in-network with your insurance, we will provide a detailed receipt, also called Superbill, which you can submit to your insurance for reimbursement using your out of network benefits
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If different from patient
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        Thank you for choosing us for you mental health care needs. We look forward to seeing you soon!

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