Forward Thinking Counseling



Forward Thinking Counseling Services

Danielle Williams, MSW

2905-A Hewitt AVE

Everett, WA 98201

425-319-2977



Sliding Rate Fee Schedule

(As of 3/9/09)

Individual Therapy

Annual Net Household Income Counseling Fee Per 50 minute session

0-$29,999 $40

$30,000-$39,999 $50

$40,000-$49,999 $60

$50,000 + $70

Couples or Family Therapy

(2 or more individuals in a session)

$15 more than the individual rate

(fee schedule subject to change at any time)

• Net income means how much you are paid after taxes and other deductions have been subtracted.

• All fees are due at the time of services unless other arrangements have been made.

• At this time, Forward Thinking Counseling Services does not accept nor bill insurance. You will get a receipt for services, which you can submit to your insurance company, and they may or may not reimburse you. If you would like to be reimbursed by your insurance company, it is recommended that you check with your insurance company prior to starting services with Forward Thinking Counseling Services to find out if services are reimbursable or not.

• At this time, Forward Thinking Counseling Services does not accept Medicaid or Medicare.

• Acceptable forms of payment are cash or checks payable to Danielle Williams.

• There will be a $25 charge for returned checks.

I have read and understand the fee schedule. Based on my (our) annual net household income, my individual counseling fee per session will be_______ _____ , our couple or family counseling fee will be________________.

Signed:__________________________________________________________ Date: ________________________

Signed: __________________________________________________________ Date: _______________________

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