FORMS
Forms to review and keep for your records
If you would like me to coordinate care with another treatment provider (e.g., primary care physician, school counselor, psychiatrist), complete this form to authorize release of psychotherapy information:
NO Suprises Act
The "No Surprises Act," which was reinforced beginning January 1, 2022, requires that psychologists give uninsured and self-pay patients a good faith estimate (GFE) of costs for services that they offer. The GFE is a notification of expected charges for a scheduled visit. Every patient with whom I work will know in advance my fee.
The "No Surprises Act," which was reinforced beginning January 1, 2022, requires that psychologists give uninsured and self-pay patients a good faith estimate (GFE) of costs for services that they offer. The GFE is a notification of expected charges for a scheduled visit. Every patient with whom I work will know in advance my fee.
| good-faith-estimate-notice.pdf |