Good faith estimate

 

You are entitled to receive this “Good Faith Estimate” of what the charges could be for psychotherapy services provided to you. While it is not possible for us to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. This estimate is not a contract and does not obligate you to obtain any services from any clinician at Ascend Coaching and Therapy, nor does it include any services rendered to you that are not identified here.

 

This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you and your clinician agree to in consultation. For example, some clients with a higher intensity of symptoms start out with more frequent sessions, approximately one per week, and then move to biweekly sessions within 1-2 months. Many clients will attend one psychotherapy visit every two weeks, but the frequency of psychotherapy visits that are appropriate in your case may be more or less, depending upon your needs.

 

You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.

The fee for a 50-minute psychotherapy visit (in-person or via telehealth) is $ 150.

 

Based upon a fee of $150 per visit, if you attend one psychotherapy visit every other week, your estimated charge would be $300 for two visits provided over the course of one month; $600 for four visits over two months; or $900 for six visits over three months. If you attend therapy for a longer period, your total estimated charges will increase according to the number of visits and length of treatment.

 

You have a right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). Please speak to your clinician at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.

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Date Created: February 2, 2026