Under Section 2799B-6 of the Public Health Service Act and the federal No Surprises Act, you have the right to receive a “Good Faith Estimate” of the expected cost of services from any health care provider, including mental health providers, when you are not using insurance.

If you are paying out of pocket without using insurance, you have the right to receive a written estimate of how much your care will cost before we begin.

Before you start therapy with me, or upon request, I will provide you with a written Good Faith Estimate that includes:

• The expected cost of each session
• The anticipated frequency and duration of treatment, based on the information available at the start
• Any other charges you might reasonably expect

I’ll provide this estimate at least one business day in advance of any scheduled service, and you can request one earlier if you’d like.

A Good Faith Estimate is exactly what it sounds like, an estimate. It is not a guarantee. The actual cost of your care may differ if treatment changes course, if we add or remove services, or if your needs change in ways that aren’t yet clear.

If you receive a bill that is at least $400 more than the Good Faith Estimate I provided, you may be eligible to dispute the bill through the federal Patient-Provider Dispute Resolution Process. You have 120 days from receiving the bill to start the dispute. Information about that process is available at www.cms.gov/nosurprises or by calling 1-800-985-3059.

You can request a Good Faith Estimate before scheduling any service, or at any time during the course of treatment. To request one, contact me or ask during your initial consultation.

I recommend that you save a copy of your Good Faith Estimate for your records. Estimates are also available on request at any time.

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Last updated: May 10, 2026