Form Form

New Client Application Form

Please fill out this form completely. 

Yvonne Sinclair LMFT is not accepting new clients in the Lincoln Office 

Yvonne Sinclair LMFT no longer accepts TriCare or MHN insurance. 

Sorry for any inconvenience. 

Lincoln Office or Yuba City Office

Choice of Counselor at Lincoln Counseling Center

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 Tuesday (not accepting new clients in Lincoln at this time)
Yvonne Sinclair LMFT-Yuba City Office hours on Monday, Wednesday, and Thursday
Lanee Weesner LMFT-Lincoln Office hours (contact her for times and days)


Merchant Services
Note: All prices in US Dollars
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