Forms
Professional Disclosure Statement
Release of Information Consent Form
New Client Information Form
Perreard Professional Billing Insurance Form
Gender Dysphoria Questionnaire
Note: When completing electronic forms with multiline responses, please click or tab to the subsequent line to continue your statement so all of your text is visible on the PDF prior to submission. You may also need to click a second time to ensure your cursor is in the proper field prior to typing.
Rates
$210 per 55-minute session
$52.50 each additional 15 minutes per session or phone calls exceeding 15 minutes
$300 initial intake session (insurance clients only)
$100 no-show fee
Insurance
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:
- Do I have mental health insurance benefits?
- What is my deductible, and has it been met?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
- What is my out-of-network coverage?
I am in-network for the following insurance companies:
Oregon
-
- Aetna
- Allcare
- AllCare Medicare Advantage
- AllCare OHP
- BCBS PPO
- Carelon
- Cigna
- First Health
- OHP/Medicaid
- OHP Open Card
- Oscar Health
- Oxford
- Pacific Source
- Quest Behavioral Health
- Regence
- United
New Mexico
- Aetna
- BCBSNM
- Carelon
- Cigna
- Quest Behavioral Health
Note: I will soon take Presbyterian Health Plan; Presbyterian Medicare and Medicaid; and BCBSNM Medicare and Medicaid.
Colorado
- Aetna (multiple plans)
- Anthem BCBS HMO and PPO
- BCBS PPO
- Carelon
- Certivo Elwood Group
- Cigna (multiple plans)
- Claim Doc
- Fairos by OccuNet
- Lucent health
- Medical Mutual
- Optum Carveout
- Optum/United EAP
- Oscar Health
- Oxford
- Quest Behavioral Health
- Simplified Benefits Administrators
- TriWest
- United (multiple plans)
- Unity Preferred network
- Unity Preferred Workman’s Comp
- Velocity National Provider Network
- Velocity National Provider Network Workers Comp
Reduced Fee
Reduced fee services are available on a limited basis.
Payment
Cash, check, and all major credit cards accepted for payment.
Cancellation Policy
If you do not show up for your scheduled therapy appointment and you have not notified me at least 24 hours in advance, you will be required to pay $100 for the missed appointment.
