FEES & FORMS
Adult Intake Questionnaire Form
Child/Adolescent Intake Questionnaire Form
Child/Adolescent Intake Legal Forms
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HIPPA Privacy Practices Notice
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Forma de Admisión Para Adultos
Consentimiento Informado para Teleterapia
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As part of the No Surprises Act, beginning January 1, 2022, if you’re uninsured or you pay for health care bills yourself (don’t have your claims submitted to your health plan), health care providers and facilities must provide you with an estimate of expected charges before you get an item or service. This is called a “good faith estimate.” Providers and facilities must provide you with a good faith estimate if you request one, or after you’ve scheduled an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services that are provided as part of the same scheduled experience.
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Most insurances are accepted. We are in-network providers with Aetna, Aetna FirstHealth, Ambetter, Beacon/Value Options, Blue Cross Blue Shield PPO & HMO Plans, BCBS Medicaid, Cigna, ESI EAP, Interface EAP, Lifeworks EAP, Lucet SCAN Medicare, Magellan, Magellan EAP, Medicare, Molina, Mutual of Omaha EAP, Optum, Oscar, Sendero, Scott & White Health Plan, Scott & White Right Care, Surest, Superior Medicaid, Traditional Medicaid, Tricare, Triwest & United. We are out-of network providers with GEHA . We are actively working to add more insurance providers. Please contact us to determine if we accept your insurance.
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We participate in the Veteran's Choice Program. If you are a Veteran and don't have Tricare, feel free to contact us and we will help coordinate mental health services.
If we do not accept your insurance, the private pay rate is $75-$120 per clinical hour for individuals, families and couples. A clinical hour is defined as 53 minutes.
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We also offer sliding scale and pro-bono counseling options that range from $15-$75. Please contact us to determine if we have open slots, or to add your name to the waitlist.
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We accept all major credit cards, cash and checks. We also accept Health Savings Account (HSA) & Flexible Spending Account (FSA) credit cards.