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New Client Forms & Fees


Payment is collected at the time of service.  Cash, checks, and all major credit cards are accepted for payment.  I do not accept or work with insurance beyond offering a Superbill (itemized receipt) upon request that you can provide to your insurance company to try to seek reimbursement.  If you know that you would like to have a Superbill you will need to speak with your insurance company with any questions.


If you need to cancel your appointment, please leave a message at (816) 585-3673 at least 24 hours prior to your scheduled appointment time.  Any cancellations made less than 24 hours in advance of the scheduled appointment, or not coming to the scheduled appointment will result in being charged the full session fee for the missed appointment.  Payment is to be paid in full prior to scheduling future sessions.  Failure to give adequate notice repeatedly may result in services being terminated.


In compliance with the No Surprises Act that went into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing.”


This Act requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.


Additionally, we are required to provide you with a Good Faith Estimate of the cost of services upon request and/or prior to your scheduled appointment. Although it is difficult to determine the true length of treatment for mental health care as each client has a right to decide how long they would like to participate in mental health care, a good faith estimate will be provided and reassessed as needed.

Your Rights Under This New Act:

  • You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate.


For questions or more information about your right to a Good Faith Estimate, visit or call 1-800-985-3059.

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