412-450-0518 [email protected]

PAYMENT & FORMS

Resources for Clients

Therapy services may be covered in full or partially based on your health plan.

Please check your healthcare coverage before your initial session. Also, you may want to ask your provider the following questions:

  • Do I have outpatient mental health benefits?
  • Are there limits to the mental health therapy I am able to receive, and if so what are they?
  • Do I have to choose a therapist from a specific provider list, and if so is your therapist on it?
  • Do I have a deductible and if so, has it been met?
  • Do I have a copay and if so, how much is it per session?
  • How many sessions per calendar year does my plan cover?

Payment Methods

Cash, checks, and credit cards (Visa, MasterCard, American Express, Discover) are all acceptable methods of payment.

Payment is due when services are rendered.

Client Forms

Please find all the forms you will need for your initial consultation below. For your convenience, you can fill all of the forms out online and e-mail them back to your preferred provider, or, print out these forms to fill out to bring with you to your initial consultation.

To complete the online forms, please save the forms to your computer and complete using Adobe Acrobat. For more information and help, please visit: 

Client Information

Before your initial consultation, please take a moment to fill out the Client Information Form so we can be prepared to help serve you better.

Client Insurance Information Form

Policy for Electronic Communications

Intern Informed Consent and Therapy Agreement

Consent to Treatment of Minors

HIPAA Privacy Notice & Authorization Form

Informed Consent & Therapeutic Agreement for Psychotherapy Services

Authorization for Release Exchange of Information

Group Therapy Agreement Form

Group Therapy Client Information Form

Release of Liability for COVID-19

Would you like to talk? Contact us to schedule your initial consultation.

East End Office

1789 South Braddock Ave., Suite 350Pittsburgh, PA 15218

Phone
: 412-450-0518
Fax: 412-727-7475
Email: [email protected]