Forms, Fees and Insurance

Client Forms
Please right click to download (save), print and complete your client forms and bring them with you to your first visit:

Insurances accepted:
I take many insurances either as an in network or out of network provider and will bill them for you. Check with your plan to find out actual coverage prior to visit as coverage will vary.

I do require payment for your portion at the time of service. Once you understand your specific benefits and coverage we can estimate your copay and set up your first appointment.

My fees: If you pay cash, my fees vary between  $150 and  $350  depending on nature of service and time required. Payable at the time of service.
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:

  • Do I have mental health benefits?
  • What is my deductible and has it been met? What is the date it starts over again?
  • How many sessions per calendar year does my plan cover?
  • How much does my plan cover for an out-of-network provider?
  • What is the coverage amount per therapy session?
  • Is approval required from my primary care physician?

Forms of payment: Cash or checks are accepted at the office. You may also pay by Visa, Mastercard or American Express.

Cancellation policy: Except for medical emergency or your illness, if you do not show up for your scheduled appointment, and you have not notified me at least 48 hours (business days) in advance, you will be required to pay a fee of one hundred dollars.    Sometimes I may allow a phone appointment  in lieu of office visit.

You can request an appointment online through email or calling 208-918-0958.