Good Faith Estimate

Under federal law, you have the right to receive a Good Faith Estimate of the expected cost of services if you are not using insurance or are choosing to self-pay.

If you choose to enter treatment, Lindsay Tucker may provide the following services:

• Individual psychotherapy

• Individual psychotherapy intensives

• Family psychotherapy, conjoint psychotherapy with client present (commonly referred to as relationship counseling)

• Family psychotherapy intensives

• Psychiatric diagnostic evaluation

Current fees for these services are outlined in the signed informed consent and fee agreement. The annual Good Faith Estimate is based on your hourly rate multiplied by 48, representing the maximum number of weeks of services offered in a calendar year.

This Good Faith Estimate reflects an approximate annual cost of services and is not a contract. The total cost of treatment may vary depending on the frequency, duration, and type of sessions provided over the course of care.

If you believe you were billed substantially more than this estimate, you may contact the U.S. Department of Health and Human Services within 120 days of receiving the bill.

For more information about your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 800-985-3059.