Forms & Fees
New clients please complete/review the following forms.
Please print and review the Informed Consent Agreement and Child/Adolescent Information Form. If you don’t have any questions or concerns, please complete them and bring to your first appointment. If you do have questions, please let me know before or at your first appointment.
Please complete the credit card authorization form. Most families keep a credit card on file for all sessions and other fees to be charged. It is not required, but allows for all session time to be focused on therapy. If you prefer to pay by check or cash, it is still appreciated to have a card on file for any late cancellation fees.
The Professional Disclosure Statement and Notice of Privacy Practices (standard HIPPA agreement seen in medical offices) need to be reviewed prior to your first appointment. There are no signatures needed for these two documents.
Additional Forms. Please complete as appropriate.
Thriving Families is in network with First Choice Health Network, Pacific Source Private, Medicaid Open Card, and EBMS. Sessions are eligible for out of network benefits with other insurance companies. Please check with your insurance company to understand your benefits. Sessions are $130-180 for 50 minutes. Intake appointments are $130-200.