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.

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At your request, we will gladly provide you with a “Good Faith Estimate” to help you estimate the expected charges you may be billed for receiving couple therapy. Please contact us to request this form.