FORMS & FEES

Some important things to know and do before our first meeting.

Fees

Out-of-Network Provider

I am an out-of-network provider and do not have an agreement with any insurance plan. However, your insurance plan might still reimburse you for some of my services under your out-of-network mental health benefits. At your request, I can provide a receipt for services that can be presented to your insurance company. Please check with your provider regarding out-of-network benefits.

Flat Fee

I charge a flat fee for professional services; however, there are cases where I charge less. I let my clients know upfront: If you need to talk immediately, please call free of charge. Similarly, the cost per session can be adjusted in case of financial hardship.

Individual Counseling: $190 per session

I start individual counseling with one, 90-minute intake session followed by regular, 60-minute sessions.

Couples Counseling: $225 per session

Couples counseling begins with a 4-session assessment:  a couples session, followed by individual sessions with each partner, then a summary session where we review goals and next steps. Couples intake sessions are 90 minutes each, ongoing couples sessions are 60 minutes. 

Couples therapy is not typically covered by insurance.

FORMs

To save time during your first meeting, please review these forms and either send via email or bring them with you.

GOOD FAITH ESTIMATE
Your rights regarding billing transparency — no signature required
DOWNLOAD NOTICE >
Intake
Contact information, reason for seeking services
DOWNLOAD INTAKE FORM >
Telehealth video conferencing
Fill out if you would like the option of virtual sessions (optional).
DOWNLOAD TELEHEALTH FORM >
INFORMED CONSENT
Explanation of Services and Confidentiality
DOWNLOAD INFORMED CONSENT >
HIPAA PRIVACY NOTICE
Privacy on your health information — no signature required but good to read
DOWNLOAD PRIVACY NOTICE >
HIPAA PRIVACY NOTICE CONSENT
Signed consent for your health information
DOWNLOAD PRIVACY CONSENT >

Therapy involves a
special conversation
from which
new possibilities
emerge.