Fees

Call for rate. A discounted rate may be available for those individuals or families who can demonstrate genuine financial need. Please discuss this with me directly before our first session

Payment is due at the time of service. You may pay by cash, credit card, or check made payable to "Sam Jolman, MA LPC." To pay by credit card, click the button below. Payments are made using Paypal, a secure online payment website.

At this time, I do not accept insurance directly. However, you may be able to receive reimbursement yourself, since I am a Licensed Professional Counselor. I will gladly issue you a receipt if your insurance company reimburses for out of network providers. When you use your insurance company, they and your employer have access to your confidential file and information. Often times, if you need to change health insurance or receive life insurance, this information and diagnosis can be researched. I would urge any person seeking therapeutic help to consider the confidentiality consequences and long term outcomes of using your insurance company.

To download, click on the relevant paperwork below. New Client Forms contains all the necessary paperwork for new clients. Use the Specific Forms for separated documents or for forms I may have asked you to print off. All forms are in .PDF format. You will need Adobe Acrobat Reader to view them. It can be downloaded for free by clicking the Adobe Reader link below.

Information Form Disclosure Statement Notice of Confidentiality Counseling Policies Confidentiality Waiver

Consent to Treat a Minor Parent Permission Form No Harm Contract

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