Psychotherapy for Amelia Island, Fernandina Beach, Nassau County

Forms, Fees, and Payments

Forms

For your convenience you may complete the following intake forms before your appointment and bring them with you:

Informed Consent
Client Information Form
Financial Sheet

This is your HIPPA form. Please print out and keep for your records:

HIPPA

If you wish for me to be able to communicate about your treatment with others such as your doctor or your partner, please complete the following and bring it with you as well:

Client Limited Release

If you will be requesting EMDR treatment please complete the following:

EMDR Consent

 

Session Information and Fees

Free Mini-Session:
Because your relationship with your therapist is so important, I offer a free 15-20 minute in person or phone session to help you decide if I am the right therapist for you. Please let me know if this what you are requesting when you call to make the appointment.

Therapy:
Sessions: Sessions are a full 60 minutes.

Fees: $100. Per hour session
I accept cash, check, Mastercard, Visa, Paypal

Insurances Taken
Blue Cross Blue Shield
Ceridian
Cigna
Humana
Tricare Standard
United Healthcare
ValueOptions

Payments

You don't need to have a PayPal account to use this service, you can use a credit card, debit card, or a PayPal account if you have one. You will get a receipt via email from PayPal after your complete your payment.

Enter Amount You Want to Pay:

Click Button Below: