Coaching Fee Schedule and Financial Policy   

OFFICE:   978 413-9118  

FAX: 978-610-2213  

BILLING: 978 264-4851                                                                

Consultative Services

Written Reports by request   $160.00  Per hourly rate  

Consultation (phone, school, agency, another therapist)  $160 per hour or per time used    

Private Pay Services (Self Pay)    

Coaching Services for Extended sessions

Initial Evaluation   90791   50-60 Min     $200.00           

45 min Individual Meeting   $150.00

45 min Couples/Family Meeting   $175.00

60 min Individual Meeting   $200.00

60 min Couples/Family Meeting    $230.00

75 Min Individual Meeting   $250.00

75 min  Couples/Family Meeting   $280.00

90 Min Individual Meeting   $300.00            

90 min Couples/Family Meeting   $330.00

No Show/Late Cancels

Failure to keep a scheduled appointment without 24 hour advance notice will result in a charge equal to your regular rate being due from you and are your responsibility.

Payment Policy:

• Payment is expected prior to or at the time of service for all self-pay clients.

• Payments can be made by: cash/electronic payment in the exact amount , check made payable to: Frederique C Begin, LICSW, or via credit card agreements either monthly or one time.

I have read and agree to Frederique C Begin, LICSW’s Financial Policies.  Please note that Fee Schedule Increases may occur based on increased costs but you would be notified in advance of any change.

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 Patient or responsible party Date

Name_________________________    Signature _____________________________  Date____________