Forms & Fees

Professional Disclosure 

Office Policies

Client Information

Credit Card Authorization

HIPAA Policy

*Click the download button and from there you can print each fie or download. 

Payment

FEES:  My basic fee is $120 per 50-minute individual session and $150 per 50-minute couple session. Longer or shorter sessions are prorated from this basic fee as such:
Individual 50 min session: $120
Individual 80 min session: $160
Couple 50 min session: $140
Couple 80 min session: $210

Do I accept insurance?

I am currently not an “in network” provider. Most people I work with pay out-of-pocket.

I do accept payment with HSA/FSA cards which is a common supplement to insurance benefits.

As an out-of-network provider and cannot bill insurance companies directly. However, I can provide receipts for you to submit to your insurance company for possible reimbursement or application of fees towards your deductible. I advise new clients to contact their insurer with questions about coverage for out-of-network mental health providers. I suggest asking your insurance provider to see if your plan includes any “out of network” benefits for “outpatient office visits” with a “Licensed Professional Counselor Intern”.

Let’s get started!

Contact Harley