Good Faith Estimate Notice

Under the No Surprises Act, you have the right to receive a Good Faith Estimate (GFE) explaining how much your therapy services may cost. If you believe you have been billed unfairly beyond the estimated amount, you can dispute the charge through the U.S. Department of Health & Human Services (HHS) by calling 1-800-985-3059 or visiting the website below.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

Your Rights Under the No Surprises Act

If you are uninsured or not using insurance for services, you have the right to:

• Receive a written Good Faith Estimate before your first scheduled session, detailing the expected costs of therapy.

• Request a Good Faith Estimate at any time before scheduling or during treatment.

• Dispute a bill if you are charged at least $400 more than your estimated cost.

What to Expect

• The estimate will include the cost of services I provide, based on your individualized treatment plan.

• Therapy is a collaborative and evolving process, so the frequency and duration of treatment may change based on your needs. If so, we can discuss an updated estimate.

• The Good Faith Estimate is not a contract—you are not required to commit to services based on this estimate.

If you will be using your insurance to pay for your services, the Good Faith Estimate does not apply to you. You will only be financially responsible for your co-pay and, if applicable, any standard no-show/late cancellation fees.