Forms:
Required: These forms may be completed on-line by following the link in your welcome email.
| Client Information |
| informed Consent |
Optional: To coordinate care with any other provider (such as school counselor, prior therapist, psychiatrist) about any aspect of your psychotherapy please fill out the form below. One per provider. This form is also available on-line.
| Release of Information |
Couples Counseling:
Please print out and complete these forms prior to your first appointment.
**These forms are not available on-line.
| Couples 1 |
| Couples 2 |
The next form is optional
| Couples 3 |
Rates:
$250 per 50 minute individual session
$275 per 50 minute couple session
75 and 90 minute sessions available and billed accordingly
$275 per 50 minute couple session
75 and 90 minute sessions available and billed accordingly
Reduced fee services are available on a limited basis.
Insurance:
I am an out of network provider on all insurance plans. I will provide you with a statement of psychotherapy services that you may submit to your insurance company for reimbursement. Services may be covered in part by your health insurance or employee benefit plan. When you check your coverage the following questions may be helpful:
- Do I have mental health insurance benefits?
- What is my deductible and has it been met?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session for an out of network provider?
- Is approval required from my primary care physician?
Payments:
Payments accepted via Venmo, Zelle, credit or cash. Payment is due on the date of service.
To make a payment scan the QR codes below:
To make a payment scan the QR codes below:
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Venmo
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Zelle
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