Disclosure – Confidentiality Form
An Informed Consent, Disclosure Statement will be reviewed together, discussed and signed at the first session.
Sessions and Cancellations
Sessions are 60 minutes long, unless otherwise agreed. Cancellations require 24 hour notice, or payment for the full session is due at the next appointment.
Payment in full is due at the time of each session, by cash or check.
Fee for first session (intake/assessment) is $150.
Fees for parent/child or families are $120 per session.
Fees for couples, $120 per session.
Fees for individuals is $120 per session.
Telephone consultation will be charged at $25 per 15 minutes. Payment is due at the beginning of your next scheduled session.
Routine calls and scheduling calls of less than 10 minutes are no charge.
Out of office work, such as consultation with school or physician will be scheduled with advance parental agreement and billed at $120 per hour, including travel time. These services will be billed to you at the next session and payment will be required at that time.
Until 10/31/2021, I take the following insurance: Regence, Blue Cross, Premera, and Lifewise. I add companies over time, so call and ask if I am a current network provider. If I do not take your insurance, all sessions are private pay. I can provide paperwork (1 page) for you to submit to your insurance company for possible reimbursement for out-of-network services on your plan. Not all insurance companies reimburse for out-of-network. Call yours and ask. Starting Nov 1, 2021, I will no longer take any insurance. At time of service, full payment will be required. Upon request, I will provide “SuperBills” for you to submit to your insurance for possible re-imbursement.