Client Information Sheet
Please read the following information carefully. Feel free to discuss any concerns or questions that arise. A copy of this sheet will be emailed to you when this form is completed.
- All fees are for individual, couples, or family therapy per session. Each session is 45 minutes.
- Feese are payable a the end of each session. Clients may pay fees in advance.
- Clients will be billed for sessions that are not canceled or rescheduled, without 24 hours notice given to the therapist. Insurance cannot be billed for sessions that are canceled without 24 hours notice.
- Strict confidentiality according to the ethical principles of both the American Psychological Association and the National Society for Clinical Social Work. These ethical principles require exception to confidentiality only under such circumstances as when a client presents a serious danger to themself or someone else, or reports abuse to a minor.
- The following chart is used to determine sliding scale fee rates:
|Gross Family Income||0-2 Dependents||3 + Dependents|
|$90 – 100,000||$140||$140|
|$80 – 90,000||$130||$130|
|$70 – 80,000||$120||$110|
|$65 – 70,000||$110||$100|
|$60 – 65,000||$100||$90|
|$55 – 60,000||$90||$80|
|$50 – 55,000||$80||$70|
Insurance may or may not cover services provided. Clients may discuss coverage with the therapist and assistance may be provided in obtaining reimbursement from the insurance company.