Helpful Forms

 Please complete the following forms for your first appointment:

Adults in California click here

Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for
medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of
any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you
choose, for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of
your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate visit www.cms.gov.nosurprises