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Forms and Fees

Feeling and Healing Counseling


Child Intake Form

Please fill out this form if your child (3-17) will be receiving therapeutic services.


Adult Intake Form

Please complete this form if you are 18 and up. This can be used for individual, couples, or family therapy services.


Release of Information

Please fill out this form if you would like information to be released to a school counselor or teacher, doctor, psychiatrist, family member, etc.

Fee Agreements

Therapy sessions are scheduled for 60 minutes. 50 minutes will be spent with the client and the final 10 minutes will be used by the clinician for documentation. Payment will be done through a credit card placed on file during the intake process.  My fee is $125 per session and payment will need to be completed at the time of session. I offer a sliding scale based on financial situation and need. Please reach out to met personally to discuss flexibility of rates.

If a third-party will be paying for sessions, we will complete additional forms stating that they will be responsible for the payment of therapeutic services.

If you are unable to attend a scheduled appointment  at least 24 hours notice is required. If there is not 24 hours notice, you will be billed for the missed appointment unless there is an emergent situation. 

While I am not currently paneled with any insurance companies, I am able to give a monthly super-bill statement with charges that can be submitted to your insurance company.

I do not serve as a witness or provide testimony at court hearings.

A Good Faith Estimate is...

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