Form Form

New Client Application Form

Please fill out this form completely. 

Yvonne Sinclair LMFT no longer accepts TriCare or MHN insurance. Sorry for any inconvenience. 

Yvonne Sinclair LMFT is not accepting any court ordered clients. 

If a court report or court appearance may be requested, please let me help you find a different therapist. 

Lincoln Office or Yuba City Office

Client's Name

If client is a minor please state their age.

Insured persons name, if different than client

Insured person's ID number

Insurance Information

Please provide all information in this section. I will need all to bill your insurance for you.

Insurance Company

Name of company, authorization number, claims address, and
Insured ID number if not listed above.

Insurance Authorization Number

Claims Address for Insurance Billing, (not the one on your card)

Your best contact email address

Your best contact Phone Number

Issues to be addressed

Best time of day for appointment-

Yvonne Sinclair LMFT-Lincoln Office hours on every other Tuesday (not accepting new clients in Lincoln at this time)
Yvonne Sinclair LMFT-Yuba City Office hours on every other Tuesday, and Every Wednesday, and Thursday

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Note: All prices in US Dollars
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