Patient Forms & Information

Helpful Forms

See below to view and print forms for you first appointment. By filling out this paperwork ahead of time, we can spend most of the session talking about your concerns and current situation. I thank you for your patience with these forms. They can be lengthy, but are legally and ethically necessary. Feel free to contact me at 717.208.0774 for further questions

Patient Information

Rates
Professional fee is $90.00 for a fifty- minute individual session and $110 for a couple’s session. Payment is expected at the time of service.

Insurance
I am an Out-Of-Network provider, which is accepted by most insurance companies.  A fee-for- service is paid by the client in full, and a form is given to you to than bill your insurance company. Please check your coverage carefully by asking the following questions:

Do I have a mental health insurance benefits?
What is my deductible and has it been met?
How many sessions per year does my health insurance cover for out-of-network?
What is the coverage amount per therapy session?
Is approval required from my primary care physician?  

Cancellation Policy
Appointments are reserved exclusively for you. If you are unable to show up for your scheduled appointment, please let us know at least 24 hours in advance to avoid the No Show/Late Cancellation fee. The No Show/Late Cancellation fee is a standard fee of $50.00. Should you cancel within the 24- hour time frame and I am able to fill your exclusive appointment time that day, the fee will be waived.