Fees & Forms

Client Forms

Please download, read, fill out and sign these documents before coming in for your first appointment. The disclosure statement is something I need to provide you by law which simply states the way I work and some of the laws governing our work. The intake form will provide me some background information about you, which will help us in our work, and will help me begin to get to know you.

Intake Form - Patti Nequette - Print, read and sign one per person

Therapy Disclosure Statement - Print, read and sign one per person

Privacy Practices - No need to print, please read

Fees

Appointments are either 55 minutes or 80 minutes long and are billed at the following rates:

  • First session $160.00
  • Individuals, 55 minutes $125/hr
  • Lifespan Integration: 80 minutes $185.00

I have limited sliding scale sessions available, based on gross income:
Annual Gross Income Rate

  • $60,000 + $125/hr
  • $40,000 – 59,000 $95/hr
  • $0– 40,000 $85/hr

Insurance and Payment

I am a preferred provider with: Kaiser Foundation Health Plan Options, and First Choice

If you are using insurance such as Kaiser Foundation Health Plan Options, or First Choice, I will bill for our first session. Please remember to bring your card. You will need to contact your insurance company to confirm your co-payment or co-insurance amount, which is due at time of service. Also, if your deductible has not been met you are responsible for paying in full the allowable amount for mental health counseling. If you have other insurance, payment is due at the end of our session and I can provide you with a receipt to be submitted for possible reimbursement. Most insurance plans reimburse my fees 50-100%. I accept cash, and credit, debit cards, but prefer checks.

Interested in our services?

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