FORMS AND FEES

STP_5490 STP_5481

Prior to your first appointment complete the forms below by clicking on each link and printing each form. Please remember to bring the completed forms with you to your appointment.

 Mental Health Intake Form

Client Fact Sheet

Financial Policy

Informed Consent

Notice of Privacy Practices

Consent to Use and Disclose Your Health Information

The fees for counseling services vary according to your payment source.  Generally, if you are using an EAP (Employee Assistance Program) through your employer, there are no fees assessed to you. The EAP program will cover  most of your expenses, with the exception of any additional reports or paperwork you may request (such as FMLA or Social Security Disability forms) that are not included in the EAP agreement.

If you are utilizing your health insurance benefits, you may be required to pay co-insurance, a co-payment, or deductible for your sessions, depending on your health insurance plan. Co-payments and co-insurance payments are due before each session starts. Deductibles are the out of pocket amount that you must pay before your insurance will pay. We require a $25.00 deposit to secure your appointment. This deposit will be credited toward any co-pay, co-insurance or deductible.

Clients that prefer not to use EAP or health insurance benefits may pay privately. The intake fee for the first session is $125.00 and the fee per follow up therapy sessions is $100.00 for 50 minutes. We accept Visa, Mastercard, Discover, and personal checks. There is a $30.00 fee for returned checks. Payment plans are also available.

All appointments will be secured with a $25.00 credit card deposit that will be credited towards your first visit. We require 24 hours notice if you need to cancel or reschedule your appointment. We provide reminder notification of your appointments forty-eight hours prior to your appointment via voicemail or text message, which ever your prefer. Missed appointments that do not provide 24 hour notification will be charged the rate of the missed session.

Need to Talk?