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
Lincoln, CA Office
898 5th street, Suite B. - Yvonne/Every other Tuesday, Wait list only at this time
Yuba City, CA office
1634 Poole Blvd. #400 (allstate office), Every other Tuesday and every Wednesday and Thursday
If client is a minor please state their age.
Insured persons name, if different than client
Insured person's ID number
Please provide all information in this section. I will need all to bill your insurance for you.
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
Would you to be added to the wait list?
No thank you
Only if there are no times available now.
All prices in US Dollars
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