Please use the following documents to prepare for our first appointment


Forms

The following forms must be completed and brought with you to our first appointment

Family Information 


Mandatory Disclosure 



Parents often ask if they can meet alone with me prior to my sitting with their adolescent or child. If you desire to use insurance, your child must be present for at least part of the initial session. You may ask for time alone to share any concerns privately but insurance requires that I sit with your child for the initial evaluation.

If you are paying privately, your child does not need to be present until you desire for me to meet with them.

Please bring with you as well any former reports, evaluations, etc. that you feel may be helpful for beginning our time together.

CONSENT TO RELEASE INFORMATION:

We can discuss whether or not you need to fill this form out during therapy. If you desire to grant me permission to speak to another professional regarding your treatment, or to receive information from someone regarding previous treatment, please fill out the Consent to Release Information form.

If you are seeking an evaluation for medications, e.g. ADHD from a physician they need to fill out the 'Consent to Release Information' form in to have information released to their physician


Fees

PRIVATE PAYMENT:

If you do not have insurance, or chose not to use it in order to maintain another level of confidentiality, I am willing to work on sliding scale. I am amenable to having a conversation about a reduced fee depending on circumstances of the household. 

If you can truly afford my fee, please do not ask for a reduction. 

I reduce my fees for those who have limited income and would not otherwise be able to retain treatment. My desire is to be available for someone no matter what their financial situation. If you are asking for a reduced fee, I will ask you to honestly share (and possibly supply evidence) of your annual income / need.

Please bring payment for each session with you.

Initial consultation  $150.00

When using insurance, the initial visit requires an exploration of diagnostic issues and can feel different than your weekly therapy session. Think of it as the first look at a map. I’m trying to figure out where you are, where you desire to go, and what’s necessary to get you there.

Follow-up visits  $150.00

INSURANCE:

Please call and research your benefits if you decide to use them.
I accept most PPOs, Tricare and Medicare Insurances.