Registration

First Appointment

Registration Forms

As a Licensed Psychologist in NY, I am dedicated to providing you with the highest quality mental health care. To begin your journey toward better mental health, please provide your name and email below and you will be sent a link to our Client Portal. All necessary paperwork must be completed prior to our first appointment.

Please enable JavaScript in your browser to complete this form.
Name

GOOD FAITH ESTIMATE Information:

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan with coverage or a Federal health care program, a “Good Faith Estimate” of expected charges. This must happen both orally and in writing upon request or at the time of scheduling health care items and services. This also pertains to people not seeking to file a claim with their plan.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises