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Hawaii Clinical Psychology

Forms & Fees

Dr. Cynthia J'Anthony, PhD
To make an appointment call: 808-778-5755

Payment for Services

Fees for individual assessments & treatment are determined on a sliding fee scale. 

Insurance accepted: *
HMSA, HMAA, TRICARE, UHA, MEDICARE, QUEST, VA CCN

*   New insurance carriers are added periodically. Please ask if your insurance carrier is not listed above.
Forms
These are the forms we usually go over during your first session.
(If you prefer, you may print them and bring them with you to the session to save time.)
  • Informed Consent                       
  • Patient Intake Form                     
informed_consent_062616.pdf
File Size: 97 kb
File Type: pdf
Download File

intake_form_121516.pdf
File Size: 135 kb
File Type: pdf
Download File

  • Notice of Privacy Practices        
  • Patient Privacy Consent Form  
Notice of Privacy Practices
File Size: 103 kb
File Type: pdf
Download File

Patient Privacy Consent Form
File Size: 62 kb
File Type: pdf
Download File

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  • Home
  • Anxiety
  • Trauma Recovery
  • Behavioral Health Care
  • Forms & Fees
  • About
  • Blog
  • Contact