Client Forms

Client Counseling Agreement

Client Intake Form

Release of Information Form

Diet Log

Client Payment

At this time we work on a cash basis only and do not accept insurance payment. We do have a sliding scale to assist clients with special finacial needs. Sliding scale rates vary between $50 – $100. per hour. Clients can also buy prepaid session packages which are offered at a discount to make services financially available. Packages must be paid in full in advance. Payment is expected at the time of service unless payment arrangements have been made with the counselor. Failure to pay for services can result in an interruption of services.

In Person or Phone Session = $100. for 60 minute session

In Person or Phone Session = $130. for a 90 minute session

In Person or Phone Session Prepaid Package: (3) 60 minute sessions for $275. (Save $25.)

In Person or Phone Session Prepaid Package: (3) 90 minute sessions for $340. (Save $50.)

This button is for miscellaneous payment amounts.