Fee Agreement Information

Still Waters Counseling Fees
 

Psychiatric/Medication Assessment – $250

Med Reviews / Follow-up Visits  – $165 – $215

Initial Assessment – Counseling   – $225.00

Individual/Family Counseling  – $195.00 (60 min); $135.00 (45 min); $105.00 (30 min)

Crisis Intervention Contact – $195.00 / hour; $100.00 (each additional 30 min)

Psychological Testing  –See provided estimate

Court Appearance – $300.00 / hour (including travel and preparation time)

Group Therapy – $45.00 / hour

Completion of Paperwork for Outside Entities (e.g., disability forms) – $50.00 per hour     

Coordination of Care – $135 (60 min); $70 ($30 min)

Clients are responsible for payment of all fees. We will be happy to submit a claim to your insurance company or provide you with a receipt for submitting your insurance claim. However, clients are ultimately responsible for payment of their bill.

Fees are payable at the time of service. A fee will be charged for appointments canceled without a 24 hour notice or if an appointment is missed without notice. See the Missed Appointment /Late Cancellation Fee Agreement form for additional information about these fees.

There will be a $20.00 fee for each check returned for insufficient funds or other reasons, plus any fees charged
to us by our bank.

If payment becomes problematic for you, we are willing to develop a payment plan for you. However, if you fail to communicate with us about your bill or do not follow through on the payment plan, we reserve the right to turn your account over to collections. Your signature below gives us the right to report any unpaid amounts
to collections. You also agree that you may be held liable for attorney fees, court costs, collection fees or other costs involved in collecting any unpaid amounts.