Demographics and Financial Agreement

Informed Consent for In Person Services

Informed Consent for Telehealth Services

Credit Card/HSA payments: please call the office to request a Square invoice or for more information

Good Faith Estimates: For clients without insurance or those choosing not to use their insurance for psychotherapy, according to the No Surprises Act, you are entitled to a Good Faith Estimate of expected charges. While it is not possible for me to know in advance how many sessions a person would need or would be recommended, a Good Faith Estimate can provide an estimate of the expected costs of services. These are provided each quarter and may include a range of services. Your total cost of services will depend on the number of sessions you attend, your response to treatment, and other individual factors. Estimates are typically discussed with clients and their parent(s)/guardian(s), in the cases of clients who are minors.