Attached at the foot of this page are documents that explain in detail my practice philosophy and structure, and a schedule of fees. Also below are the client forms that are required to be completed prior to our initial intake session. These forms should be downloaded and filled in only after an intake session has been confirmed and scheduled. Bring the completed forms to the intake session.
Payment Terms and Insurance
Please note that I accept payment by cash, check, credit card and via PayPal. Although I do not accept insurance, I can provide a confirmation of counseling services receipt form that is accepted for reimbursement by most insurance carriers and flexible spending accounts.
If you plan to submit a counseling receipt form to your insurance provider for reimbursement, please be prepared with basic insurance information (e.g., name of provider, group number, member number) at your intake session.
Phone or Video Sessions
For sessions conducted via phone or video conference when we cannot meet in person, payment may be made through PayPal by clicking the link below. If you do not have a PayPal account you may create one via this link as well.
(Note: for PayPal payments please add 2.9% (.029) plus $0.30 to the total session fee)
Contact Form
In the contact form below, please describe to the best of your ability the issues or areas of concern that you would like to address.
Forms
Here are the three forms to be filled out and brought to the intake session:
Intake Form New Client Questionnaire New Client Information
As a Licensed Professional Counselor, I am licensed, and my practice is regulated, by the State of Texas. The Texas State Board of Examiners of Professional Counselors is the licensing body, and my license number is 13766.
All questions, comments or complaints regarding my practice should be addressed to the Board of Examiners, or the Texas Department of State Health Services, by calling toll free 1.888.963.7111 or by email, at customer.service@dshs.tx.us.
If you are a client and and have questions about, or believe that you have a claim under, the Health Information Portability and Accountability Act (HIPAA), you may contact the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, Washington, D.C. 20201.