Reach Out Today

  • Home

  • What is TA?

  • About Raja M. David

  • Additional Services

    • Psychotherapy
    • Forensic Assessment
    • Traditional Psychological Evaluations
    • Trainings & Consultation

  • Resources

    • Referring Professionals
    • FAQ
    • Forms
    • Billing

  • Therapeutic Assessment Text

  • Contact

  • More

    Use tab to navigate through the menu items.
    mnccta-logo.png

    Forms

    MNCCTA Informed Consent for Psychotherap

    Informed Consent for Psychotherapy

    MNCCTA Therapeutic Assessment Informed C

    Informed Consent for Therapeutic Assessment

    MNCCTA HIPPA Notice 12.19.pdf

    Health Insurance Portability and Accountability Act (HIPPA) Document

    Release of Information 12.19.pdf

    Release of Information

    MNCCTA Financial Contract 7.21.pdf

    Financial Contract

    MNCCTA Guide for OON 11.19.pdf

    Guide for Reimbursement of Out-of-Network Benefits for TA

    Sample of a superbill for a Therapeutic Assessment

    MNCCTA Super Bill Example.pdf
    Contact MNCCTA
    • Black Facebook Icon

    651.442.3038    |    1595 Selby Avenue, Suite 204, Saint Paul, MN 55104

    F:​888-854-6467 

    © 2020 MNCCTA. Website Designed by Mally Creative.