Forms for New Clients
All new clients must complete the teen or adult information sheet as well as the "Consent for Treatment" form. If you'd like me to collaborate with or talk to another professional, such as a psychiatrist or guidance counselor, please complete the "Release of Information Form" as well.
All files can be downloaded and completed electronically, then printed and brought to your first appointment or sent via email to Amy Fantalis or Wendi Haldeman prior to the session.
Consent for Treatment | |
File Size: | 49 kb |
File Type: |
Teen Information Form | |
File Size: | 65 kb |
File Type: |
Release of Information | |
File Size: | 35 kb |
File Type: |
Confidentiality Agreement | |
File Size: | 47 kb |
File Type: |
Fees & Insurance
Hourly fees for individual appointments range between $130-$175/session, depending on the therapist. We sometimes work on a sliding scale and welcome discussion if you need a fee reduction. The fee for group is $85 per weekly session.
Our practice is fee for service and we do not participate with insurance companies. However we are able to provide monthly or as needed receipts for submission to your insurance company. If you have out of network benefits and have met your deductible, you may be eligible for some reimbursement. We suggest that you contact your insurance company to research this further.
We accept cash, checks or credit cards as payment. Our preferred method of payment is by check. Payment is appreciated at each session.
Our practice is fee for service and we do not participate with insurance companies. However we are able to provide monthly or as needed receipts for submission to your insurance company. If you have out of network benefits and have met your deductible, you may be eligible for some reimbursement. We suggest that you contact your insurance company to research this further.
We accept cash, checks or credit cards as payment. Our preferred method of payment is by check. Payment is appreciated at each session.
cancellation policy
Kindly give a minimum of 24 hours notice when canceling an appointment to avoid being responsible for full payment of the session. If you give less than 24 hours notice and we can schedule your hour, we do not charge. Missed sessions are charged for in full.