Forms & Rates
Forms
The three forms below need to be completed and returned by email before your first session. This helps therapy begin with a clear understanding of the boundaries, expectations, and protections in the relationship.
*Each form below has two options to complete. Must have a google account to complete using Google Forms (easiest option). Alternatively, there are links to PDF forms that can either be completed electronically or print/scan and then emailed.*
Client Intake Form (Google Form) OR Client Intake Form (link to PDF)
Informed Consent (Google FORM) OR Informed Consent (link to PDF)
Contact Information and Credit Card Authorization (Google FORM) OR Contact Information and Credit Card Authorization (link to PDF)
Sometimes there are situations where you will want information shared to/with another one of your providers. This could be for many reasons but since you determine access to your private health information a signed Release of Information (ROI) is needed before anything can be shared. This will be discussed more in sessions to determine if/when needed.
Rates
Therapy is an investment in yourself. Every dollar spent goes directly towards a valuable service individually tailored to your specific needs and issues. Your time and energy are extremely valuable and therapeutic work will be focused and engaging.
Clients with Growth and Gratitude, PLLC have improved their relationships and reduced anxious thoughts and feelings. This can be measured in improved relationships, higher self-esteem, and lessened anxiety and depression.
Standard session fees:
FREE | 20 minute Phone Consultation
$175 | 50 minute Telehealth Video session
$250 | 90 minute Telehealth Intensive
$55 | 20 minute Phone Consultation (as needed)
*CUSTOM session arrangements and scheduling available by need and request*
Technology allows for more frequent communication and check-ins. Contact me today to discuss how we can customize a therapy plan to meet your needs.
Insurance
For clients seeking the highest degree of privacy and choice, paying out-of-pocket is the preferred option. You will enjoy the most confidentiality of any payment option and you will not be labeled with a mental health diagnosis, which all insurance companies require.
For clients that decide to use their insurance benefit for therapy please know Growth and Gratitude, PLCC is only able to accept:
United Healthcare
Aetna
BCBS (Illinois residents ONLY)
Payment
Credit or Debit payments for PRIVATE PAY are made thru Square and INSURANCE PAYMENTS are processed thru Headway, which are easy tools to use that are designed to meet your privacy and security needs. Payment authorization is required prior to a scheduled session so that the time is reserved specifically for you and we can use our time to focus on your individual therapeutic needs. A credit card will be held on-file to facilitate this and will be charged the same day of the session. This will be discussed in the initial FREE 20min phone consultation.
Cancellation Policy
If you are unable to attend a session, please make sure you cancel at least 24 hours beforehand. Otherwise, you will be charged for the full rate of the session.
Any Other Questions
Please contact me for any additional questions you may have. I look forward to hearing from you!