New Client

Before coming to your first appointment, please bring the following documents completed to the best of your ability:

  • Welcome Letter (Please read and sign to become familiar with our practice and policies)
  • Release of Information (One form for each person you would like us to share information with i.e. psychiatrist, primary care doctor, child’s teacher, etc)
  • Intake Form

We look forward to meeting you at your first appointment where your counselor can get to know you and discuss any questions that you may have about any of the above documents.    In addition to the completed forms requested above, please also bring your insurance card.

Children under the age of 18, must be accompanied by a parent or legal guardian.  In some situations the parent or guardian chooses to attend the intake session without the child in order to share information with the counselor without the child present.

When you arrive at Footprints Counseling, please seat yourself in our waiting room and your counselor will warmly greet you at your designated appointment time.

 

Payment Information

Footprints Counseling accepts the following payment methods: Cash, Check, Credit Card, FSA, HSA and some insurances.

Please contact us to find out which insurances we currently accept prior to your first appointment.

A sliding fee scale is also available and can be discussed with your counselor.

Good Faith Estimate

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 or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

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 www.cms.gov/nosurprises