Forms

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Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Note: To download Adobe Acrobat Reader for free, click here.

 

Rates & Insurance

Rates
$130 per 50-minute session

Insurance
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:

  • Do I have mental health insurance benefits?

  • What is my deductible and has it been met?

  • How many sessions per year does my health insurance cover?

  • What is the coverage amount per therapy session?

  • Is approval required from my primary care physician

  • Reduced fee services are available on a limited basis.

Payment
Cash, Check and Visa and Mastercard are accepted for payment.

Cancellation Policy
If you do not keep your scheduled therapy appointment with Susan Hammonds-White and you have not notified us at least 24 hours in advance, you will be required to pay the full cost of the session.