Forms & Fees
Please complete the forms below, every person must complete the first two forms. Before your first visit, send completed forms to firstname.lastname@example.org. Your insurance will be verified and you will be notified via email regarding your behavioral health benefits deductible and co-payment.
- New Patient
- New Patient Transgender
- Patient Service Contract
- Payment Authorization
- Child Intake
- Two Way Release
- Partner Diagnostic Questionnaire
For clients with mental or behavioral health insurance coverage; The initial consultation is $250 for 75 minutes. Additional sessions are 50 minutes at $180. (Initially, you might want to plan for 10 sessions to address your concerns.)
Payment options: Cash or Credit cards only( %4 interest charge fee), or PayPal.
For clients with mental or behavioral health insurance coverage, monthly, I will give you a "superbill" which can be submitted to your insurance company for possible reimbursement.