Lotus Mind Services
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W9

Required for all insurance panels - fillable in Adobe

W9 (pdf)Download

Blue Cross Additional Forms

Fillable in Adobe

Areas of Expertise (pdf)Download
Provider Disclosure Form (pdf)Download

Community Care Application

No need to download the form. I have posted it so you have information as to what they are looking for if you are considering applying for their panel. I will fill out the information and send a form asking for the answers to page 3 and 4. 

Download PDF

Tricare

Credentialed vs. Certified

Download PDF

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In quiet memory and dedicated to my husband - Jeff Pitts

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