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Good Faith Estimate

Understanding Your Rights and Costs

Prior to scheduling services, you may request a Good Faith Estimate of expected charges. Under the federal No Surprises Act, you have the right to receive an estimate of costs for services provided at this private practice.

In accordance with Ohio licensing board requirements, you will also receive a written Informed Consent Form outlining the actual cost of services. This document must be reviewed and agreed upon before services begin and before any charges are incurred.

Important Information About Estimates

Fees and Agreement

Before starting services:

You will receive a written informed consent form with session fees
You must agree to these fees prior to receiving services
Fees remain in effect unless updated in writing

If fees are updated, you will be required to review and agree to the revised informed consent form before any changes take effect. Otherwise, agreed-upon fees remain valid for twelve (12) months.

Discontinuation of Services

Dispute Process

While you have the right to initiate a dispute under the No Surprises Act if there is a significant difference between estimated and actual charges, this situation is unlikely. This is because you agree in advance to the exact cost of each session through the informed consent process, in compliance with Ohio licensing board rules.

Information about initiating a dispute process is available upon request.

Questions or Requests

If you would like to request a Good Faith Estimate or have questions about fees and billing, please reach out for more information before scheduling your appointment.

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