Fees are $100.00 for a 60-minute session. I do reserve some sessions for a sliding scale. Please feel free to check with me on the availability of this, if you need it. I am happy to discuss this with you.

I work as an out of network provider. Currently I am not on insurance panels. I can provide you with an invoice statement for you to submit to your insurance company or flex spend for reimbursement.

I accept cash, check or credit card payment via Square. Please note that Square adds an additional fee for all credit and debit card charges. Payment as you come in is appreciated, so we can spend the rest of the session talking about what is on your mind.

Forms

Please follow these instructions carefully and bring in these forms to our first meeting together. You will need to read and print off two copies of the HIPPA and Disclosure Statement. Please feel free to ask me any questions about either that you do not understand or would like me to elaborate on them.

After you have read them, please sign both copies of the two forms and bring them in.  I will also sign both copies and retain one for my records and give you a copy of each of them for your records.

You only need to print and fill out one copy of the Information form, and bring that in at the same time. This will be for my records.

So, there needs to be a total of 2 HIPPA, 2 Disclosure Statements and 1 Information Form, brought in on our first appointment.

In order to access these forms, you will need to have Adobe Reader installed on your computer. To print these documents, click on the document file below to open it, then click on “File” then “Print”. To download the forms, here are the instructions:

For Windows/PC:

1. Click your right mouse button (or left if you use a left-handed mouse) on the document file link.
2. Choose “Save Target As” (for Microsoft Internet Explorer browsers) or “Save Link As” (for Netscape or Mozilla browsers).
3. Select the destination directory to download the file to, and click “Save.”

For Mac/OS:

1. Either “Control” + “Click” or click your right mouse button (or left if you use a left-handed mouse) on the document file link until the menu pops up.
2. Choose “Save Linked File As”.
3. Select the destination directory to download the file to, and click “Save.”

Document Files:

HIPAA

Disclosure Statement

Client Information Form

Debi Circle (303) 514-4732 or click here to contact me.