Forms + Fees
Please complete the intake form prior to your first session.
After completion of the form you may either email it to us at firstname.lastname@example.org, or you may print out the completed online form and bring it with you to your session.
What are the reasons to self-pay instead of using insurance benefits?
Grief is a normal and natural process and we do not use the medical model and treat grief as a mental illness with a diagnostic code. Some people have high deductible insurance plans that they likely won't meet within the year. As fee-for-service providers we do not give you a mental health diagnosis, therefore, it allows you and the counselor to determine the length of counseling and an individualized plan. The insurance companies will not have access to any of your private health records unless you choose to release the records which assures that everything discussed in your counseling sessions is confidential.
One 50 minute session: $95
Three 50 minute sessions: $250
Five 50 minute sessions: $425
If you need to cancel a scheduled appointment, please do so at least 24 hours in advance. If you do not cancel a scheduled appointment with at least 24 hours notice, or if you fail to attend your scheduled appointment you will be expected to pay a $60 cancellation fee.
Payment is due at the time of service.
Checks, cash, HSA cards/flex spending cards, and all major credit cards are accepted for payment