Forms

Please Print, Complete and Bring these for our initial session

Forms for all to complete:

New Client Information Form

New Client Consent Form

Forms for those with weight, eating and healthy lifestyle concerns:

Adult and Adolescent Weight-Related Questionnaire

Youth Weight-Related Questionnaire

Insurance and Fees

 

I am an out-of-network provider for all commercial insurance companies.
My fee is collected at each meeting.

As a service to you, I promptly submit electronic claims to your insurance company requesting that reimbursements be sent directly to you.

My current fee for each 45-minute treatment session is $240. 
My current fee for the initial 60-minute assessment/goal-setting/skill-introduction session is $320.

If you have genuine financial need and no out-of-network insurance, please call to speak with me about the possibility of a discounted fee

Insurance and Fees

I am an out-of-network provider for all commercial insurance companies.
My fee is collected at each meeting.

As a service to you, I promptly submit electronic claims to your insurance company requesting that reimbursements be sent directly to you.