GOOD FAITH ESTIMATE – CLIENT RIGHTS NOTICE

Effective date: June 18, 2026

Your rights to a Good Faith Estimate

Under the No Surprises Act (federal law), healthcare providers are required to give clients who are uninsured or not using their insurance (self-pay) a written estimate of expected costs before services are provided.

The Good Faith Estimate is based on information known at the time the estimate is created and does not include emergency healthcare services.

You have the right to receive a Good Faith Estimate that includes:

  • The expected cost of therapy services (individual, couples, family sessions)

  • The expected frequency and duration of services

  • Any other items or services reasonably expected as part of your care

Timing of your estimate

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

If your bill is higher than expected

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. To protect yourself:

  • Make sure to save a copy or picture of your Good Faith Estimate

  • Compare your bill to any bill you received

  • Contact us immediately if there is a discrepancy

Important notes

  • A Good Faith Estimate is not a contract and does not require you to obtain services

  • Actual cost may vary if your clinical needs change during the course of treatment

  • This estimate does not apply if you are using health insurance – your costs will be determined by your insurance plan’s benefits

Questions or more information

You may contact us:

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059