Fee Agreement
Fees
Usual and customary fees for professional mental health services are:
| Priority Retainer | $1000 |
| Individual Assessment & Treatment Plan | $750 |
| Emergency Consultation (60 minutes) | $300 |
| Family/Marital Therapy (50 minutes) | $250 |
| Individual Counseling/Therapy (50 minutes) | $200 |
| Consultation (60 minutes*) | $200 |
Payment
Accepted forms of payment are cash, money order, PayPal or credit card. Payment is required prior to or the same date services are administered or upon scheduling online. A receipt will be issued upon request of the client.
Hours remaining when half- or full-day interventions are completed to the satisfaction of the client(s) will be credited for follow-up counseling and consultation at the hourly rates listed.
Client or collateral client refusal to complete the contracted services will not suffice to warrant reimbursement of fees.
Prior Notification
In the event that an appointment is made that cannot be kept, cancellation or rescheduling must be done 24 hours in advance except in case of extreme emergency.
In the event of failure to keep an appointment in the absence of emergency, without prior notification, a $100 penalty fee will be assessed.
Financial Need
Life circumstances may at times limit the ability of my clients to pay usual and customary rates listed above. When such circumstances exist, an alternative agreement, or, to make referrals that might allow client(s) to receive needed services that can be reasonably afforded. The number of reduced fee arrangements are limited and are determined on a case-by-case basis.
Reimbursement/Refunds
No refunds will be made for prepaid services under any circumstances except when the provider deems it appropriate.
Clinical Intervention fees and related expense payments ARE NOT REFUNDABLE.
Intervention Fee Agreement
Fees
Usual and customary fees for professional intervention services are:
| Out of state comprehensive intervention | $6,000 minimum |
| In state (Colorado) comprehensive intervention | $3,600 minimum |
| Priority clinical retainer (7 hrs x $150) | $1000 |
| Urgent counseling (60 minutes*) | $300 |
| Scheduled counseling (60 minutes) | $200 |
| Intervention Associate consultation (hr, grad level) | $100 |
| Intervention Associate consultation (hr, undergrad) | $60 |
min ½ hr increments ** min ¼ hr increments
Payment
Accepted forms of payment are cash, money order, PayPal or credit card. Payment is required prior to or the same date services are administered or upon scheduling online. A receipt will be issued upon request of the client.
Hours remaining when half- or full-day interventions are completed to the satisfaction of the client(s) will be credited for follow-up counseling and consultation at the hourly rates listed.
No refunds will be made for prepaid services under any circumstances except when the provider deems it appropriate. Client or collateral client refusal to complete the contracted services will not suffice to warrant reimbursement of fees.
Prior Notification
In the event that an appointment is made that cannot be kept, cancellation or rescheduling must be done 24 hours in advance except in case of extreme emergency. In the event of failure to keep an appointment in the absence of emergency, without prior notification, a $100 default fee will be assessed.
This form details the agreement we have formed, and serves as our contract for psychotherapy services, per the following signed agreement.
Reimbursement/Refunds
No refunds will be made for prepaid services under any circumstances except when the provider deems it appropriate.
Clinical Intervention fees and related expense payments are non-refundable.
Lodging, travel time and expenses are non-refundable.
