You have the right to receive a "Good Faith Estimate" outlining the potential charges for the psychotherapy services you will receive. While it's challenging for a psychotherapist to predict the exact number of sessions you may need, this estimate gives you an idea of the potential costs involved.

Your total expenses will be influenced by various factors including the number of sessions you attend, your individual circumstances, and the type and extent of services provided to you.

There may be additional items or services I may recommend as part of your care that must be scheduled or requested separately and are not reflected in this good faith estimate. This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified here. 

You have the right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges).

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you.