Davis Counseling & Play Therapy Center, P​LLC​​

Fees, Client Information, and Forms

Fees 

The fee for the intake session is: $100 (60-120 minutes)

The fee per counseling session for individuals (including child/adolescent or adult) and parent sessions are: $100 (50-60 minutes)  

The fee per counseling session for a family session with the child present is: $100 (60-75 minutes)

The fee per counseling session for relationship counseling (or marital/couples counseling) is:

 $150 (60-75 minutes)


Insurance & Payment Options

Insurance is not accepted for payment for counseling services. This allows for the utmost protection of your privacy and confidentiality. Third-party payers require personal information to include name, demographics, diagnosis/symptoms, level of functioning, and therapeutic progress in the processing of insurance claims. 


Please Note: Davis Counseling & Play Therapy Center, PLLC does not accept health care insurance and is considered out-of-network for individuals who are insured under their health care insurance plans. Therefore, potentially resulting in some or all of the amounts paid for counseling services not counting towards your current health care plan’s deductible or out-of-pocket limit.

All services provided by Davis Counseling & Play Therapy Center, PLLC are billed as self-pay only. 

If requested, a "superbill" can be provided for you to file a claim for reimbursement with your insurance company. 


In situations of financial need, on a case-by-case basis, a sliding pay-fee scale (income-based) option can be provided for those with financial difficulties in obtaining counseling services where a reduced fee is provided.


Payment

Acceptable forms of payment include cash, check, and most major credit cards. However, due to the COVID-19 pandemic, contactless payment is required through the TheraNest Client Portal or via the Square Terminal to minimize contact when making payments at this time.


Appointments

Morning, afternoon, and evening appointments are available for your convenience, and appointments are scheduled by appointment only. Walk-in appointments are not available.


Cancellation Policy

If you fail to show up for your scheduled appointment time, and you have not notified the counselor by phone or email at least 24 hours in advance to cancel or reschedule your appointment, you will be required to pay a $50.00 no show/late cancellation fee. 


Voicemail/Email messages are checked numerous times during the day and in the early evening. I will make every effort to be available to you. 


If you are experiencing an emergency, please contact the Crisis Hotline, 627-LIFE (5433) or the local Crisis Hotline, Chesapeake City Crisis Care Emergency Line 757-455-0368, or dial 9-1-1 for immediate assistance. Please visit the closest hospital emergency room for psychiatric evaluation and acute intervention for further treatment care needs.


Please DO NOT use email to communicate emergencies. 

PLEASE NOTE: If you need to send confidential correspondence (e.g., information, forms, etc.), please send to [email protected] via Hushmail, a well-known HIPAA secured email service. Otherwise, please DO NOT send confidential correspondence to [email protected]

Thank you.

Resources and Guidance Documents Regarding the "No Surprises Act" [H.R. 133]: (Effective January 1, 2022) 

Click here for Standard Notice and Consent Regarding Surprise Billing Protection 

Click here  for Notice of "Right to Receive a Good Faith Estimate of Expected Charges"

Click here for "Good Faith Estimate for Health Care Items and Services"

Forms

Click here for Welcome Letter

Click here for Biopsychosocial Intake Form for Adult

Click here for Biopsychosocial Intake Form for Child and Adolescent

Click here for Consent for Working with Minors Form

Click here for Marital/Couples or Family Therapy Consent Form

Click here for Therapy Consent, Policies, and Procedures Agreement Form

Click here for Telehealth Consent Form (for current/existing clients ONLY)

Click here for Telehealth  Counseling Policies, Duties, and Procedures Agreement Form (for current/existing clients ONLY)

Click here for Important Telehealth Information (Getting Started Tools)  

Additional Guidance on Telehealth from Person Centered Tech