New Client Forms
Scheduling an Appointment
- Fill out the New Client Form and drop off or mail to: 4449 Easton Way, 2nd Floor, Columbus, OH 43219 -OR- fax to: (614) 358-BLU2 (2582)
- Once the New Client Form is received, this provider will reach you to schedule an appointment.
- If you do not hear back from Bluestone Vitality, LLC within one week of delivering the New Client Form please call (614) 636-BLUE (2583).
- Call: (614) 636-BLUE (2583) -OR-
- Email: firstname.lastname@example.org
- Please do not leave any confidential information in a voicemail or an email.
- At this time this provider is not in network with any insurance companies.
- $160 for the Initial Evaluation
- $140 for a 50 minute follow up appointment
- $80 for a 20 minute follow up appointment
- $100 for 20 minute follow up appointment with addiction medication management (drug screen requirements)
- $20 for injections
- $20 surcharge for evening, weekend or holiday appointments
Please note that this provider does NOT bill your insurance company. You can submit the claim for your appointment to your insurance company, but it is not guaranteed that your insurance company will reimburse any of the claim.
- Credit Card (preferred payment type) – including Visa, MasterCard, Discover or Debit Card