Client Forms

If you are new, please fill out these intake forms prior to the first session.

Client Intake Form

Consent for Treatment

Controlled Substance Agreement

If there’s anyone you would like to share your medication record with, simply fill out the following form

Authorization for Release of Information

Rates & Insurance

Rates

285

Initial Psychiatric Assessment

120

Medication Management Follow-up appointment

170

Medication Management Follow-appointment w/cognitive and behavioral skills training.

Insurance

I accept Aetna, Cigna, Optum, Oxford, and United Healthcare.

Depending on your current health insurance provider or employee benefit plan services may be covered in full or in part. Please contact your provider to verify that behavioral telehealth (medication management through video) is covered.

I would recommend asking these questions to your insurance provider to help determine your benefits:

K

Does my health insurance plan include mental health benefits?

K

Does my plan cover behavioral telehealth services?

K

Do I have a deductible? If so, what is it and have I met it yet?

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Do I need a referral from my primary care physician to receive behavioral telehealth services?

Payment

I accept payment via PayPal, CashApp, Zelle, and all major credit card. I also accept payment directly on my site via this page.

Cancelation Policy

If you are unable to attend a session, please make sure you cancel at least 24 BUSINESS hours beforehand. Otherwise, you will be charged a fee for the full rate of the session. Keep in mind that your health insurance plan will NOT pay for missed sessions.

Any Other Questions?

Please contact me for any additional questions you may have. I look forward to hearing from you!

Payments

Appointment Request