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.
Insurance and Cost:
For clients with mental or behavioral health insurance coverage; prior authorization may be required. Usually, a co-payment is due at the time of service, normally between $10 and $35 per visit after the deductible is met. I'm contracted with several insurance companies including Aetna, Anthem, Cigna, Blue Cross, Blue Shield, Horizon Health, Magellan, MHN, Optum, Tricare, Triwest, Value Options, United Health Care, UBH, UPMC, and many others.
Private paying clients sessions range from $175- $100.