Patient Information

Services Fee Schedule

All services are rendered as cash or self pay only. We can accept Venmo, Paypal, paper check by mail, or cash, all due at the time of the appointment.

Services Fee schedule
CodeDescriptionCharge
90792 Psychiatric Diagnostic Evaluation - 90 minutes $300.00
99205 Psychiatric Diagnostic Evaluation w/ Medication Evaluation - 90 minutes $375.00
90833/
99214
Individual Therapy w/ Medication management - 60 Minutes $180.00
90834 Individual Therapy w/ Medication Management w/ Client or Family - 60 minutes $235.00
90880 Hypnotherapy - 60 minutes $150.00
90880/
99214
Hypnotherapy with Medication management - 90 minutes $180.00
90853Group Therapy Session - 90 minutes$125.00
90853/
99213
Group Therapy Session w/ Ketamine - 180 minutes $350.00
99213 Office/Outpatient Visit, Simple (Established Clients) - 20 minutes $100.00
99214 Office/Outpatient Visit, Medication Management (Established Clients) - 30 minutes $125.00
99215 Office/Outpatient Visit, Complex (Established Clients) - 60 minutes $250.00
99441 Phone/Text/Email visit (other than scheduling or brief chats) $50.00
No Code Ketamine Assisted Therapy - 180 minutes $860.00
No Code Ketamine Assisted Therapy Package - 3 Sessions $2460.00
No Code Late Appointment Cancellation (less than 24 hours notice)
- 1st Late cancellation
- 2nd Late cancellation
- 3rd+ late cancellation
$0.00
$15.00
$25.00
No Code "No Show" (missed appointment without cancellation)
- 1st no show
- 2nd no show
-3rd+ no show (up to half of session fee charge but no less than $75)
$25.00
$50.00
$75.00
No Code Official Paperwork Request (Evaluation Letters, FMLA, etc.) $100.00

Patient Forms

Please print, fill out, and bring or send these forms to your first patient visit. If information has changed, please repeat this process.