Forms/Fees/Insurance

Forms

Please print and fill out the intake forms before your first session:

Intake Forms

The Agreement for Counseling form is required for divorced or separated parents:

Agreement for Counseling

This HIPAA form is required if you plan to file with insurance:

HIPAA Form

Sign the following release form to allow me to talk with other medical professionals on your behalf:

Authorization for Release of Behavioral Health Information

Fees

Individual (45 minute session)  $120 

-Child

-Adolescent

- Young Adult (18-25 years)

Family (50 minute session)  $145

Group (120 minute session)  $35/per session

Forms of payment accepted: cash, check, all major credit cards, HSA debit cards

Insurance Accepted 

Aetna

Anthem Blue Cross/Blue Shield

Cigna

Humana

Mines and Associates

Please contact your insurance provider for co-pay information and mental/behavioral health benefits.

** For out of network insurance, I will bill your insurance but session fees are due at time of visit. **

Questions regarding fees and insurance can be answered by calling:
303-669-9698

All Individual and Family sessions are by appointment 

Groups are set dates and times  

If you are interested in group therapy for your high school age teen please contact me at christa@playtherapy4kids.com


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