Therapy By The Sea
Begin Your Healing Today
(949) 933-6103
Begin Your Healing Today
(949) 933-6103
Deborah Phillips, MA, LMFT
Marriage & Family Therapist - LMFT52563
The journey of a thousand miles begins beneath one's feet
Lau Tso
The journey of a thousand miles begins beneath one's feet
Lau Tso
Registration/Intake Forms
Registration/Intake Forms
If you're an adult client (18 yrs or older), please print and complete the Adult Forms and bring them to your first therapy session. If you are coming as a couple please print and complete the Couples Forms, have spouse complete their information and BOTH sign and initial where indicated.
If you're an adult, registering a minor (under age 18), please print and complete the Children Forms and bring them to your first therapy session, with copies of court custody documents (if applicable)
Good Faith Estimate Notice
Good Faith Estimate Notice
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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.