Financial policy

Consultation is $25 per 15 minutes. Late cancel is $25 unless waived. Therapy session rates are named before evaluation or therapy begins. This is not a payment page.

Published fees

These are the only amounts published. Therapy session rates are named before evaluation or therapy begins.

Client name *Person responsible for payment *I understand the published fees

Brief telephone or virtual consultation is $25 per 15 minutesConsultation fees are private pay and are not billable to health insuranceLate cancellation and no-show fees are $25 unless waived, when less than 24-hour notice is givenEducational and IEP consultation is separately billable and named before that work whenever reasonably possible

Therapy and insurance

I understand

Therapy and evaluation fees are named before that work begins—not printed as a menu on this formA superbill may be available to submit to a health plan; coverage is never promisedThis is not a weekly package I have not agreed toThis website does not take card payments

Signature *Date *

Drafts stay on this device only. Printing creates a PDF through your browser. Emailing opens your mail app with a text summary. These templates support care and documentation; they are not a substitute for legal review of privacy or consent language.

Every journey begins with hope.
Every bloom begins with R.O.S.E.

Every bloom begins with R.O.S.E.