Coaching Clients

Please complete this form and email it back to me prior to our first appointment. This will provide you the space to begin to reflect on your life and aspects of growth and support you would like. This will assist us in formulating goals and bringing you closer to living the life you would like to lead. 

Services can be paid for in advance or at every session. I accept payment by cash, check or debit/credit card.Prepaid, discounted session packages are available to support you in your commitment to your health and wellness. Purchased sessions do not expire.​

  • Life Coaching (45 minutes) – $175 ​​
  • 3 session package – $475 (Save $50)

Therapy Clients

Please complete these form and bring them to your first appointment. This will provide you the space to begin to reflect on your life and aspects of growth and support you would like. This will assist us in formulating goals and bringing you closer to living the life you would like to lead. 

​For Clients Under the Age of 18 (complete all three)

Services can be paid for in advance or at every session. I accept payment by cash, check or debit/credit card (including HSA/FSA cards). Prepaid, discounted session packages are available to support you in your commitment to your health and wellness. Purchased sessions do not expire.​

  • Group Therapy (90 minutes) – $75 ​
  • Individual Therapy (45 minutes) – $175 ​
  • ​Couples Therapy (45 or 90 minutes) – $175 or $350
  • 3 Session Package for Individual or Couples Therapy – $475 (Save $50)

Health Insurance

I am an out of network provider for insurance companies. I am happy to provide you monthly documentation for your sessions that includes a receipt of service and payment that you can submit to your insurance company. You pay me for the therapy sessions, and your insurance company sends the reimbursement check directly to you. Often, this process is quite simple and makes working together even more affordable. It can be helpful to contact your insurance company regarding the following if you would like to use out of network benefits: 

  • Do I have mental health benefits? 
  • Is approval required from my primary care physician? 
  • What is the coverage amount per therapy session (CPT Code “90834” for a 45 minute individual therapy session; “90847” for family therapy with patient present therapy session; “90853” for group psychotherapy session)
  • How many sessions does my insurance cover each year? 
  • Do I have a deductible? What is the amount and has it been met?
  • What is the process for receiving reimbursement?

​​*This is only applicable for therapy clients. Insurance does not reimburse for life coaching

Cancellations

Please provide a minimum of 24 hours notice for a session cancellation via phone or email. This allows me to offer your appointment time to someone else who may want or need to be seen earlier. There is a full fee charge for sessions cancelled less than 24 hours in advance.

Release of Information

Information disclosed within session is confidential and not released without your written permission, except with the disclosure is required by law. Please complete the following form if you would like your records released.