Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Thank you for registering on our client portal. Please complete all the consent forms, questionnaires, demographic information, and insurance information. If you struggle or have questions, please reach out. 317-675-0233

Client Information

/ Middle Initial

( optional )
 
( Must be at least 16 years old )
( MM-DD-YYYY )


( optional )
( optional )





( for Text Message Reminders )

Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Automatic Credit Card Billing

By acknowledging this form you are acknowledging you have read and signed and agreed to the Patient Credit Card on File Agreement. You understand and agree that your card on will will be charged after each session for copays/session fees due at time of service unless prior arrangements have been made with your therapist. 


You understand and agree to your card on file being billed in accordance to policy for any and all therapy fees. If any charged are incurred and that these charges will be billed immediately to your card on file.


You understand that in order to be in services with Dotson Therapy and Associates, LLC an active and valid card must be maintained on file to bill for the appropriate charges and/or services.


Thank you!

( Type Full Name )
( Full Name )
Video Session Information/Link

Video sessions:


Join Zoom Meeting

https://zoom.us/j/7025764034?pwd=a2sva1JxcDBqY013dnREVXlYNi8yQT09


Meeting ID:  702 576 4034

Passcode: Lpt6K0cb




( Type Full Name )
( Full Name )
You must be in the state of Indiana to attend a video therapy session.

Please note that in order to attend a video therapy session you must be within the state of Indiana. I am currently only licensed to see clients in Indiana. If you plan to move, go on vacation, business trip, attend college/univeristy, etc. outside of Indiana we will need to cancel or reschedule our session until you are back in Indiana.


Thank you for your understanding!


Melissa Dotson, MS, LMHC

( Type Full Name )
( Full Name )
Late Cancellation and/or No-Show Policy (revised 1/1/2025)

Late cancellations are any services cancelled or rescheduled with less than a 24 hours notice and these are billed at a rate of $150/occurrences. These are not covered by your insurance company and will be billed directly to your card on file. You are allotted a total of two late cancellations and no show appointments (a total of two, not two each) in a 12 month period. After two late cancellations/no show appointments all future sessions will be cancelled, you will not be rescheduled and your services with Dotson Therapy and Associates, LLC will be terminated.


HIP/Medicaid/EAP clients: Please discuss this with your therapist. 

( Type Full Name )
( Full Name )