Intake Packet
intake_packet.pdf
Fee Agreement
My regular fee is $100 per session. A session is typically 50-60 minutes long. I do not bill insurance companies, though I do work with people who will get reimbursed by their insurance companies. I have a limited number of appointments for military personnel, veterans, and first responders at a fee of $25 per session.
Please feel free to begin a conversation if you feel unable to pay my regular fee.
I understand that I am responsible to pay the agreed fee at the beginning of each session. I also understand and agree that sessions are scheduled for 50-60 minutes each, and that no reduction of the fee will be given for a session shortened at the client’s request unless agreement is reached between client and therapist at least 24 hours in advance. Furthermore, I agree to the policy that notice of session cancellation must be given at least 24 hours in advance or I am responsible for 10% of the fee for the canceled session to be paid at the beginning of the next session. I understand that exceptions to this policy are made in the case of emergency or as agreed between client and therapist. Consultation by telephone longer than 15 minutes will be paid by the quarter hour – each 15 minutes charged at 25% of the agreed hourly rate.
Date:
Signature: