Forms
Preparing For Your Visit
In order to help your first visit go smoothly, I ask that you complete the following forms before arriving and bring them with you when you come.
Required Forms
1. Client Demographic Form
2. Client Rights and Responsibility Form
3. Basic Information Form
4. Acknowledgement Of Notice Of Privacy Practices
5. Service Fee Form
6. Insurance Form
7. Client Appeals
Fees And Session Information
Initial Assessment Fee: $175
Subsequent sessions are $150 for 60 minutes, $110 for 45 minutes, and $90 for 30 mins.
Accepted Insurance/EAP: BlueCross BlueShield, TN Care, Medicare, Cigna, and Medicaid.
Private pay also accepted.
If you have questions regarding your insurance or EAP coverage, please contact them prior to the first session to clarify benefits directly with your insurance/EAP provider. Please click the link below to secure your choice of appointment time and make your payment.