Good Faith Estimate (No Surprises Act)

I want you to feel informed and comfortable about the financial side of your care.

You have the right to receive a “Good Faith Estimate” explaining how much your medical or mental health care is expected to cost. This is part of a federal law called the No Surprises Act.

If you don’t have insurance or are not using insurance for services, I am required to provide you with a Good Faith Estimate for the total expected cost of any non‑emergency services, including psychotherapy.

Your Good Faith Estimate will outline:

• The type of service (for example, individual or couples therapy)

• The session fee

• How often we might meet

• The estimated total cost over a period of time (often up to 12 months)

You can ask for a Good Faith Estimate at any time—before you schedule or at any point during our work together. My goal is to be as transparent as possible so there are no financial surprises.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. Please keep a copy or photo of your Good Faith Estimate for your records.

For more information about your right to a Good Faith Estimate, you can visit:
www.cms.gov/nosurprises or call (800) 985‑3059.