Forms & Policies

Please review the Client Agreement and complete the 1st Appointment Questionnaire prior to your initial psychotherapy appointment. Reviewing these documents ahead of time will allow for more efficient use of face-to-face time. Thank you.

Psychotherapy Agreement

First Appointment Questionnaire

In order to focus on your care and give you the time and energy you deserve, I do not participate in contracts with private insurance or Medicaid. I will provide you with a receipt for services received, which you may be able to submit for reimbursement to your insurance carrier under out-of-network mental health benefits. Contact your health insurance carrier to obtain information about your specific benefits.

Health insurance can be a wonderful benefit to utilize; however, with respect to mental health care, there can be some limitations:

Insurance companies require a diagnosis for services to be covered. Not all problems that people struggle with and bring to therapy fit a diagnosis. From the perspective of the insurance company, a mental health diagnosis demonstrates “medical necessity” for therapy services. However, not all diagnoses in the Diagnostic and Statistical Manual of Mental Disorder, 5th Edition (DSM-V; the classification of mental disorders used in the United State), are viewed as “medically necessary” by insurance companies.

Additionally, that diagnosis follows you permanently. The diagnosis may impact future premium rates or your ability to obtain other types of insurance (e.g., life, disability insurance) in the future.

Finally, utilizing your health insurance may reduce aspects of the confidentiality of your information that is shared in therapy sessions. Insurance companies may request additional information about your circumstances and the treatment progress in order to process payments or reimbursements. Once the information goes to your insurance company, it may be seen and reviewed by several individuals.

If you have questions or concerns about the fee structure, do not hesitate to call 614-843-1009.