Schedule Your Appointment

Forms, Fees, & Policies

We need all information 2 business days before your appointment. If we don’t have all information in a timely manner, it will delay your appointment. 

Thank you!

Needed forms, for first appointment:

Driver’s license – send photocopy to our email or fax.

New Client Intake Packet

Financial Agreement

HPPGA Credit Card Authorization

If using insurance, copy of insurance card (front and back)

Additional Forms:

(Some of the forms are informational only. See below).

Sliding Scale Agreement

Third party payor (If someone else is paying for an adult client) – Third party must send their photo id.

Notice of Privacy Practices (full document)

Release of Information

Fees

Letter to our clients – 2024 Policy Changes

(click button below to SIGN letter)

We accept cash and some insurance plans. Certain services may not be covered by your insurance. If we are aware of a service that insurance does not cover, we will let you know in advance.

Insurance companies do require a diagnosis, to determine reason for support.


Counseling Services: (50 – 55 minutes)

$150- Initial Assessment
$130- Standard Counseling Session 

Insurance Plans Accepted:
(Please check to see which insurance your therapist accepts) 

  • Aetna
  • Amerigroup
  • Blue Cross Blue Shield
  • Cigna
  • United Healthcare

*Sliding scale – Currently we have a waiting list. 

Payment Methods:
Cash
Credit card

**All fees must be paid at the time of service.

 

Policies

*Free 15-minute phone consultations are available to answer any questions regarding services and therapist-client fit.

 

Insurance & Payment Policy

For more information on the “No Surprises Billing Act” please use the following link: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills

Cancellation Policy 

We definitely understand that life happens but we ask that you give us 24 hours notice if you need to cancel. Given that nature of our work, we make sure to reserve your appointment and nobody else has that appointment but you. However, there are times when a crisis will arise for another client and if we know in advance that you need to cancel, we can offer the appointment to another client in need.

We have amazing clients who work to uphold this policy, barring unexpected life events. This policy works very well to reschedule clients and help others get last minute appointments.