Forms For First Session

Please fill out the following three forms and email back to me or bring them to your first visit.  This will save time and allow us to begin your first session at your appointment time.  

Intake Form

Office Policy

HIPAA Form

(Also note that while I use protected devices on a secure network, email is susceptible to data corruption, interception, unauthorized amendment, viruses or other forms of tampering.  As a result, I send and receive emails on the understanding that I am not liable for any such corruption, interception, amendment, virus, tampering or related consequences of such acts.)

 
Private Pay Fee

The fee for private pay clients is $180 per session.  This applies to clients who do not have insurance coverage or would prefer to not use their insurance coverage. Payment is due at the beginning of session and I accept cash or online payment (see options below).  Please note that the only way to ensure complete confidentiality is to bypass your insurance as companies often require personal information to process claims according to policy.

Third Party Consultations/Reports

Any and all consultations and reports having to do with third parties requested by a client are charged at the hourly rate of $180.00, paid in advance and rounded up to the next hour.  This includes consultations with or reports for lawyers, courts, therapists, doctors and any other professional, agency or persons.  Please note that insurance will not cover the fees for consultations or reports.

Ways to Pay For Your Visits Online

Google Pay
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Venmo