Forms, Fees, Insurance & Payments

 

Electronic Forms

We realize being able to fill out forms electronically can make life easier and more efficient. Feel free to use the links below to fill out relevant forms for your treatment. Simply click the appropriate link below and then enter your name and email address and a secure copy will then be sent to us. These documents are all secure and HIPAA compliant. Please only fill out these forms after you have completed a formal intake and have been assigned to a clinician. 

New Client Paperwork (Only Fill Out After You Have Completed an Intake and Been Assigned to a Therapist)

Insurance Card Submission

Credit Card Authorization Form

Telehealth Agreement

Release of Information/Records


Fees and Insurance

Our individual, couple, and family sessions range in price from $85 - $150 for sessions with one of our full time licensed clinicians, and our group rates range from $50 to $100 per group depending on length. Because we are committed to providing services to all those who need them, we also offer reduced fee and sliding scale sessions when available. 

The Center is committed to ensuring therapy is affordable and accessible regardless of your financial circumstance. We also believe that the headaches associated with accessing your insurance benefits should not stand in your way. Because of this we submit claims, obtain authorizations and handle all of the necessary paperwork for you. All of our therapists are PPO Providers for Blue Cross Blue Shield and many of our therapists also take Medicare. While we are only “In Network” for Blue Cross Blue Shield we will still submit all claims if you have another health insurance provider and your benefits will be at the out of network rate. Before your first appointment we encourage you to contact your health insurance carrier and ask about your outpatient mental health benefits.

When you are ready to set up an initial consultation or if you just want to find out more, call our Intake Coordinator at 847-676-4447 EXT. 304


Payments

If you would like to pay your bill by credit card online please click the secure link below. This will prompt you to set up an online account which you can then use to log in and make future payments. Unfortunately our system does not allow you to check your current balance but you can make online payments.

Make a Payment


The need for care and connection is greater than ever during these unprecedented times brought on by the COVID-19 pandemic.  While we cannot meet people in person, we are currently offering secure video or phone sessions that many insurance companies have agreed to cover due to the unique circumstances.   

If we can be of help, please call our intake line to set up a new appointment.  847-676-4447 ext.0


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