PAYMENT & FORMSResources 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?
Cash, checks, and credit cards (Visa, MasterCard, American Express, Discover) are all acceptable methods of payment.
Payment is due when services are rendered.
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:
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
North Hills Office
4721 McKnight Rd., Suite 208
Pittsburgh, PA 15237